Clinical appeal nurse

Clinical Appeal Nurse

A Growing Diversified Revenue Cycle Healthcare company located in Franklin Square, NY is looking for full-time hybrid and per diem experienced Clinical Appeal Nurses for writing clinical appeals for our large clients.

The Clinical Appeal Nurse's role includes conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted. Once determined, The RN will write an appeal utilizing pre-existing criteria and other resources and clinical evidence to develop sound and well-supported appeal arguments. The RN will write first, second and third-party insurance appeal letters. This RN will interface from home or the office with our team.

Position Qualifications

• Bachelor's Degree in Nursing (Preferred) as well as a current state-issued RN license, NY preferred.
• Over 5 years of clinical experience in a hospital setting
• 1-4 years of Utilization Review/Case Management experience and Denial/Appeal process
• Experience with Managed care, Governmental and/or RAC appeals strongly preferred
• Knowledgeable of InterQual and MCG medical necessity criteria
• Working knowledge of Medicare, Medicaid and third party reimbursement methodologies.
• Computer experience in Microsoft office (word, outlook and excel) and electronic medical record review
• Have excellent verbal and written communication skills, critical thinking, organizational and analytical skills.