A healthcare company has an open position for a Remote Clinical Appeals Registered Nurse. Individual must be able to fulfill the following responsibilities: Review provider post-service appeals for Medicare and Retirement.
3+ years of experience in acute healthcare setting. 3+ years of experience with HEDIS Medical Record Review. Unrestricted Missouri/Illinois licensure as a Registered Nurse or LPN. Knowledge of CPT codes, ICD-9 Diagnosis codes and HEDIS Technical Specification Requirements.
Core Responsibilities of this position include: Provide support for CCR nurses. Conduct daily clinical review and evaluation of all service requests. Conduct coverage review. Required Skills: 5 years of clinical practice experience after completing residency training.