Licensed RN Clinical Appeals Reviewer

A company is looking for an IBR Clinical Appeals Reviewer who will analyze and respond to client and hospital claim review appeal inquiries.

Key Responsibilities :

Analyze scope and resolution of IBR Appeals and respond to various levels of appeals

Perform complex analyses, identify risk factors, and recommend appropriate actions based on regulations and medical policies

Collaborate with auditors and prepare written appeals while navigating web-based portals and online tools

Required Qualifications :

Undergraduate nursing degree

Unrestricted RN (registered nurse) license

2+ years of appeals experience (coding or auditing)

Experience with CPT-4 coding and advanced knowledge of ICD10 CM and ICD 10 PCS coding

Advanced experience with regulations, compliance, and composing professional appeal responses