Remote Clinical Appeal Writer (RN)

Job Purpose

The Clinical Appeal Writer supports the Company by reviewing insurance claims denied for payment on behalf of our client hospitals. Working closely with nurses and other team members, the Appeal Writer creates appeal letters in support of claim payment.

Duties and Responsibilities

• Review denied insurance claims
• Review patients’ medical files
• Develop strategies to reverse claim denials
• Create written appeals
• Manage and organize appeal workflow based on internal, client-based, and insurance-driven deadlines
• Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards

Qualifications

• Must be a licensed registered nurse
• Must be able to prioritize workload based on strict deadlines
• Must be a strong, effective writer
• Must be tech-savvy with ability to quickly learn new software
• Must possess a high level of reading comprehension and ability to analyze medical information and terminology
• Thorough training provided

Working Conditions

• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
• Work Environment: The noise level in the work environment is usually minimal.

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.