Virginia Licensed RN Clinical Appeals

Job Summary

A company is looking for an RN Clinical Appeals.

Key Responsibilities

• Contact insurance plans to determine reasons for claim denials and analyze claims to decide if an appeal is necessary
• Prepare and submit appeal materials, including correcting and resubmitting claims and gathering additional medical information
• Collaborate with various departments to communicate denial trends and ensure compliance with regulatory requirements

Required Qualifications

• Current unrestricted license to practice nursing (LPN, RN)
• CRCR or other approved professional certification required within 9 months of hire
• 1 to 3 years of relevant job experience
• Associates Degree or equivalent experience in Nursing or a related field
• Preferred: Bachelor's Degree and 2 years of experience in denials, utilization review, or case management