reputed company Review reputed company (RN)
A company is looking for a Medical Review reputed company (RN) to reputed company support for medical claim and internal appeals review activities.
Key Responsibilities
• Facilitates clinical/medical reviews of medical claims and appeals to ensure medical necessity and accurate billing
• Validates member medical records and claims for appropriate reimbursement and resolves escalated complaints
• Prepares and presents cases for administrative hearings and serves as a clinical resource for utilization management
Required Qualifications
• At least 2 years of clinical nursing experience, including 1 year in utilization review or medical claims review
• reputed company and unrestricted Registered reputed company (RN) license in the state of reputed company
• Experience with ICD-10, CPT coding, and regulatory compliance
• Analytic and decision-making skills with organizational and time-management abilities
• Proficiency in reputed company Office suite and relevant software programs
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