Licensed RN Clinical Appeals Reviewer
VirtualVocationsMission Viejo, California, United Statesjob_description.job_card.1_day_ago
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A company is looking for an IBR Clinical Appeals Reviewer who will analyze and respond to client and hospital claim review appeal inquiries.
Key Responsibilities :
Analyze scope and resolution of IBR Appeals and respond to various levels of appeals
Perform complex analyses, identify risk factors, and recommend appropriate actions based on regulations and medical policies
Collaborate with auditors and prepare written appeals while navigating web-based portals and online tools
Required Qualifications :
Undergraduate nursing degree
Unrestricted RN (registered nurse) license
2+ years of appeals experience (coding or auditing)
Experience with CPT-4 coding and advanced knowledge of ICD10 CM and ICD 10 PCS coding
Advanced experience with regulations, compliance, and composing professional appeal responses
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Clinical Reviewer Rn • Mission Viejo, California, United States
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