Licensed Senior Appeal Specialist

Job Summary

A company is looking for a Senior Appeal and Denial Specialist to facilitate the denial and appeal process by reviewing medical records and ensuring compliance with regulations.

Key Responsibilities

• Administer and prioritize daily tasks while applying policies and regulatory requirements
• Conduct reviews of clinical-based denials to determine appropriateness of care
• Collaborate with departments for external audits and mentor others in technical areas

Required Qualifications

• Bachelor's degree required; applicable experience may be considered
• Graduate from a nationally accredited nursing program preferred
• Three years of experience in appeals, medical necessity, or prior authorization process
• Current nursing license or multistate licensure privileges if a nursing program graduate