Pennsylvania Licensed Clinical Appeals Reviewer

A company is looking for a Clinical Appeals Reviewer.

Key Responsibilities

Process appeals while ensuring compliance with regulatory milestones

Review medical records for documentation and billing code compliance

Engage with appellants, providers, and members to gather necessary information for case determination

Required Qualifications, Training, and Education

Bachelor's degree (BSN) required

3 or more years of experience in a related clinical setting

Current and unrestricted Registered Nurse (RN) licensure

Working knowledge of InterQual criteria preferred

Proficiency in utilizing Electronic Medical Records (EMRs) and MS Office