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Remote Clinical Appeals Nurse (RN)
A company is looking for a Clinical Appeals Nurse (RN) Remote. Key Responsibilities Perform clinical/medical reviews of retrospective medical claim reviews and previously denied cases Document clinical review summaries and provide supporting documentation for denial and modification of payment decisions Assist with complex claim reviews and identify quality of care issues Required Qualifications Graduate from an Accredited School of Nursing; Bachelor's degree in Nursing preferred 3-5 years clinical nursing experience, with 1-3 years in Managed Care Knowledge of ICD-9, CPT coding, HCPC, and CMS Guidelines Active, unrestricted State Registered Nursing (RN) license in good standing Preferred: 5+ years Clinical Nursing experience, including hospital acute care/medical experience
A company is looking for a Clinical Appeals Nurse (RN) Remote.
Key Responsibilities
Perform clinical/medical reviews of retrospective medical claim reviews and previously denied cases
Document clinical review summaries and provide supporting documentation for denial and modification of payment decisions
Assist with complex claim reviews and identify quality of care issues
Required Qualifications
Graduate from an Accredited School of Nursing; Bachelor's degree in Nursing preferred
3-5 years clinical nursing experience, with 1-3 years in Managed Care
Knowledge of ICD-9, CPT coding, HCPC, and CMS Guidelines
Active, unrestricted State Registered Nursing (RN) license in good standing
Preferred: 5+ years Clinical Nursing experience, including hospital acute care/medical experience