RN Clinical Appeals Specialist - Insurance Denials

Temple-Health; Philadelphia (Philadelphia County); Presencial; USD 70.000 - 100.000; Jornada completa

Descripción de la vacante

Temple Health in Philadelphia is seeking a full-time RN reviewer to assess insurer adverse determinations through all levels of the appeals process. The role focuses on clinical evaluation and evidence-based decision making.

Candidates should have RN training from an accredited school, knowledge of ICD-10 CM coding, and familiarity with InterQual and Milliman criteria; APC coding is a plus. Multistate Compact RN license required.

Formación

• General Experience and knowledge of InterQual and Milliman criteria. Required
• General Experience and working knowledge of ICD-10 CM coding Required
• General Experience and Knowledge of APC coding Preferred

Responsabilidades

• Responsible for clinically assessing all adverse determinations made by insurers through all levels of the appeals process.

Conocimientos

ICD-10 CM coding

InterQual criteria

Milliman criteria

Educación

Graduate of an accredited school of nursing

Herramientas

InterQual criteria

Milliman criteria

Descripción del empleo

Temple Health in Philadelphia is seeking a full-time RN reviewer to assess insurer adverse determinations through all levels of the appeals process. The role focuses on clinical evaluation and evidence-based decision making.

Candidates should have RN training from an accredited school, knowledge of ICD-10 CM coding, and familiarity with InterQual and Milliman criteria; APC coding is a plus. Multistate Compact RN license required.