New York Licensed Clinical Appeals Specialist

Job Summary

A company is looking for a Clinical Denials & Appeals Specialist (Remote).

Key Responsibilities

• Reviews denial trends and identifies coding issues and knowledge gaps
• Serves as a liaison between patients, facilities, physicians, and third-party payers
• Conducts clinical reviews and formulates appeal letters to support medical necessity and appropriateness of care

Required Qualifications

• Graduate from an accredited School of Nursing
• Bachelor's Degree in Nursing preferred
• Current License to practice as a Registered Professional Nurse in New York State required
• Must be enrolled in an accredited BSN program within two years and obtain a BSN Degree within five years of job entry date
• 3-5 years of experience in Utilization Review, Case Management, and Clinical Appeals preferred