Pennsylvania Licensed Clinical Appeals Reviewer
VirtualVocationsDurham, North Carolina, United Statesjob_description.job_card.variable_hours_ago
serp_jobs.job_preview.job_type
- serp_jobs.job_card.full_time
job_description.job_card.job_description
A company is looking for a Clinical Appeals Reviewer.
Key Responsibilities
Process appeals while ensuring compliance with regulatory milestones
Review medical records for documentation and billing code compliance
Engage with appellants, providers, and members to gather necessary information for case determination
Required Qualifications, Training, and Education
Bachelor's degree (BSN) required
3 or more years of experience in a related clinical setting
Current and unrestricted Registered Nurse (RN) licensure
Working knowledge of InterQual criteria preferred
Proficiency in utilizing Electronic Medical Records (EMRs) and MS Office
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Clinical Reviewer • Durham, North Carolina, United States
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