RN Licensed Clinical Appeals Analyst

A company is looking for a Clinical Appeals Analyst.

Key Responsibilities Review and appeal clinical level denials related to managed care and insurance claims Audit medical records and prepare appeal correspondence Coordinate denial resolution efforts with payers and track denial trends

Required Qualifications , Training, and Education Licensed as an RN or LPN with a current state nursing license At least 3 years of experience as a Case Manager or equivalent Preferred 1 year of experience with medical necessity appeals Bachelor's degree desirable; equivalent job experience considered

Experience with standardized clinical guidelines, preferably Inter Qual