Tennessee Licensed Appeals AnalystVirtualVocations • Houston, Texas, United States
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Tennessee Licensed Appeals Analyst
VirtualVocations • Houston, Texas, United States
[job_card.variable_days_ago]
[job_preview.job_type]
- [job_card.full_time]
[job_card.job_description]
A company is looking for an Appeals Analyst for Medicare Part B.
Key Responsibilities
Researches and documents complex appeal or retrospective review requests in compliance with regulations
Performs thorough reviews of service appeals based on clinical documentation and contractual requirements
Conducts special projects to identify quality of care issues through clinical information reviews
Required Qualifications and Education
Associate's degree in a job-related field or graduate of an accredited school of nursing
2 years of clinical experience plus 1 year of utilization / medical review or quality assurance, or 3 years of clinical experience
Active, unrestricted RN license from the United States or compact multistate RN license
Working knowledge of managed care and healthcare delivery systems
Strong clinical experience, including home health and rehabilitation
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Tennessee Tennessee • Houston, Texas, United States
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