RN - Clinical Denials Specialist
The RN Clinical Denials Specialist utilizes a clinical nursing background to address various types of inpatient payer denials, specifically those related to medical necessity and concurrent reviews. This will include working diligently with utilization review, coders, physician advisors, other team leads and payor representatives, in order to appeal claims and resolve issues causing these denials.
Bachelor’s degree from accredited school of nursing
Minimum of 5 years’ experience, preferably in Utilization Review or Case Management, including denials processing and appeals; working knowledge of Medicare, Medicaid and third-party rules and regulations; working knowledge of Interqual and Milliman.
Current licensure in good standing in the state of Mississippi as a Registered Nurse