Pennsylvania Licensed Clinical Appeals Nurse

Job Summary

A company is looking for an Inpatient Clinical Appeals Nurse.

Key Responsibilities

• Reviews inpatient account denials to determine feasibility for appeals and collaborates with the physician advisor team for in-depth reviews
• Writes comprehensive arguments for payors and medical review boards to establish medical necessity
• Monitors payor trends and meets quality and productivity benchmarks as assigned

Required Qualifications

• Bachelor's Degree in Nursing or Specialized Diploma in Nursing
• 5 years of experience in composing clinical appeals or related fields
• 5 years of experience with payor/contract relations
• Licensed Registered Nurse in Pennsylvania upon hire
• Knowledge of medical policy criteria supporting inpatient admissions and coding for claims payment