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Medical Appeals Specialist II, Med Plaza II, 8:00a-4:30p
6 days agoWhat's your preference?
Job Description
- Req#: JR 2025-105988
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Work from home flexibility, allowing for a better work-life balance
- Collaborative and supportive work environment with a focus on patient-centered care
- Engage in meaningful work that directly impacts patient care and outcomes
- Comprehensive benefits package, including health insurance and retirement plans
What to Expect (Job Responsibilities):
- Conduct thorough reviews of clinical information to support appeals for denied reimbursement
- Prepare strong appeal letters based on clinical documentation and evidence-based guidelines
- Communicate effectively with physicians and multidisciplinary teams to ensure robust appeals are submitted
- Analyze medical records to validate services and identify potential for appeal
- Research payer policies and perform timely follow-up on account appeals
What is Required (Qualifications):
- Licensed/certified healthcare professional, such as LPN, RN, or other clinical license (required)
- Minimum of 3-5 years of clinical experience (required)
- Active, unrestricted registered clinical license (required)
- Strong knowledge of medical terminology and clinical guidelines (required)
- Exceptional oral and written communication skills (required)
How to Stand Out (Preferred Qualifications):
- Bachelor's degree in a clinical occupation, such as BSN (preferred)
- Experience with appeals and/or denial processing (preferred)
- Certification such as CCM or CPUM (preferred)
- Clinical nursing experience in a hospital setting (preferred)
- Familiarity with InterQual and Milliman Care Guidelines (preferred)
#HealthcareServices #ClinicalAppeals #RemoteWork #CareerGrowth #PatientCare
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