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Medical Necessity Clinical Appeals Consultant

Company: VirtualVocations
Location: Alpharetta
Posted on: November 18, 2023

Job Description:

A company is looking for a Medical Necessity Clinical Appeals Consultant.

Conduct in-depth medical record reviews for revenue recoupment opportunities
Provide well-written appeal arguments based on clinical evidence and payers' clinical policy bulletins
Complete root cause analyses and provide performance improvement recommendations


Graduate of accredited Nursing or Medical Discipline program with appropriate licensure
Knowledge and experience with evidence-based inpatient guidelines and criteria
At least 3 years of clinical experience
Knowledge of medical necessity and third-party payer requirements
Knowledge of basic CMS rules and regulations pertaining to reimbursable care

Keywords: VirtualVocations, Alpharetta , Medical Necessity Clinical Appeals Consultant, Professions , Alpharetta, Georgia

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