Appeal Specialist

About the Role:

We are seeking an experienced RN to join our team as an Appeal Analyst.
In this role, you will be responsible for training new hires in the clinical role to complete Utilization Management Appeals. Additionally, you will act as an RN II on the team, providing support and guidance to junior staff members.

Responsibilities: -

Train new hires in the clinical role to complete Utilization Management Appeals
Act as an RN II on the team, providing support and guidance to junior staff members
Review and analyze medical records to determine the appropriateness of care
Prepare and submit appeals to insurance companies on behalf of patients
Collaborate with healthcare providers to gather additional information for appeals
Maintain accurate and detailed documentation of all appeal activities

Education Qualification:

Registered Nurse (RN) license - Bachelor's degree in Nursing or related field preferred

Required Skills: -

Minimum of 2 years of experience in Utilization Management or Appeals
Strong clinical knowledge and understanding of medical terminology
Excellent communication and interpersonal skills
Ability to work independently and as part of a team
Detail-oriented and organized
Proficient in MS Office suite and electronic medical records systems