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Virtual Clinical Appeals Nurse in Norcross at Parallon

Date Posted: 5/17/2019

Job Snapshot

Job Description

The Clinical Appeals Nurse is responsible for handling appeals requiring clinical input or interpretation.

Duties (included but not limited to): 
Compose clinical appeal letters to send to payers for denial reconsiderations utilizing documentation, contract language, or voice recordings as applicable Present a concise medical summary within each appeal based on support from the medical record Demonstrate understanding of use of all Medical Necessity software, including but not limited to InterQual© Demonstrate ability to interpret medical payer policy requirements Strong ability to research evidence-based practices Contact appropriate parties (internal and/or external) as needed for additional information to properly formulate the clinical appeal. Determine root cause of each denial and apply company-specific coding for trending and analysis Update the patient account record to identify actions taken on the account Identify problem accounts/processes/trends and escalate as appropriate Complete all required annual training Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement” Other duties as assigned

Job Requirements

Associate’s Degree preferred
• At least one year case management experience required
• Relevant education may substitute experience requirement
CERTIFICATE/LICENSE - State RN or LPN License required (Active/Inactive)