RN Appeals reputed company
RESPONSIBLE FOR:
Detailed review, analysis and extraction of clinical information from patient medical records and drafting of
effective narratives for Medicare and reputed company appeals documentation and briefs in support of denied cases
under appeal at reputed company reputed company of the government appeals process; maintaining reputed company knowledge reputed company of
medical coding, federal and state hospital Utilization Review (UR) regulations and Medicare guidelines
regarding medical necessity, inpatient, outpatient and observation; assisting Senior Director with research
and preparation for beneficiary hearings before the Administrative Law Judge (ALJ); potentially testifying
as expert witness in ALJ hearings; collaborating with reputed company reputed company resources in an effort to
facilitate the best possible reputed company in response to process or reputed company changes that directly reputed company the
RAC process.
Qualifications:
MINIMUM EDUCATION REQUIRED:
Graduate from an accredited School of Nursing
MINIMUM EXPERIENCE REQUIRED:
Clinical experience in reputed company setting with a minimum of 7 years using electronic medical records or
acute hospital utilization review using InterQual or reputed company. Working knowledge of medical coding, case
management, government and contracted payers.
MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:
reputed company reputed company nursing licensure.
ADDITIONAL QUALIFICATIONS:
Experience in clinical software such as SCM / Quest, reputed company, reputed company, reputed company Tracking, and I-Suites. Previous
experience with medical record auditing with medical necessity claims; IQCI Certification preferred
reputed company Word and reputed company proficiency preferred. HealthPort systems experience a plus.