RN Clinical Appeals Reviewer

Job Summary

A company is looking for an IBR Clinical Appeals Reviewer - Remote.

Key Responsibilities:

• Analyze and respond to IBR Appeals and medical record reviews
• Collaborate with auditors and leadership to review claims and recommend actions
• Prepare written appeals and navigate web-based portals for data analysis

Required Qualifications:

• Undergraduate nursing degree
• Unrestricted RN license
• Minimum two years of experience in appeals (coding or auditing)
• Experience with CPT-4 and ICD10 CM/PCS coding
• Advanced knowledge of regulations and compliance in healthcare