State Licensed Clinical Appeals Analyst

A company is looking for a Clinical Appeals Analyst, responsible for managing claim denials and appeals related to hospital claims.

Key Responsibilities

Review and appeal clinical level denials, including issues of medical necessity and authorization

Audit medical records and prepare appeal correspondence

Monitor and coordinate denial resolution with payers while maintaining professional communication

Required Qualifications

Current RN or LPN license

At least 3 years of experience as a Case Manager or equivalent

Preferred 1 year of experience with medical necessity appeals

Bachelor's degree desirable, or equivalent job experience

Experience with standardized clinical guidelines, preferably InterQual