Clinical Appeals Nurse
- Heredia
- Permanente
- Tiempo completo
The Clinical Appeals Nurse is responsible for handling appeals requiring
clinical input or interpretation
**Responsibilities**:
- Compose clinical appeal letters to send to payers for denial reconsiderations utilizing documentation, contract language, or voice recordings as applicable
- Present a concise medical summary within each appeal based on support
from the medical record
- Demonstrate understanding of use of all Medical Necessity software,
including but not limited to.
- Demonstrate ability to interpret medical payer policy requirements
- ability to research evidence-based practices
- Contact appropriate parties (internal and/or external) as needed for
additional information to properly formulate the clinical appeal.
for trending and analysis
- Update the patient account record to identify actions taken on the
account
- Identify problem accounts/processes/trends and escalate as appropriate
Skills and Experience:
- Up-to-date professional license as a nursing assistant
- Proven experience in hospitalization, emergency and/or related areas.
- Intermediate handling of Office and CPR up to date.
- Availability to work in our GAM offices
- Mandatory command of the English language ( B2)
About Auxis:
L1-MM1
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