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Clinical Review Specialist

1 month ago

Washington, Washington, D.C., United States Healthcare Legal Solutions LLC Full time
Job Description

We are seeking a highly skilled Clinical Review Specialist to join our team at Healthcare Legal Solutions LLC. The successful candidate will be responsible for conducting thorough clinical reviews and interpretations of medical records and claim documentation to support the appeals of denied insurance claims.

Key Responsibilities:

  • Conduct clinical reviews and interpretations of medical records and claim documentation to identify medical necessity and support appeals.
  • Draft, review, and revise appeal letters to ensure accuracy and compliance with regulatory requirements.
  • Ensure all necessary attachments are included with appeal submissions and that page number citations correspond with the medical record.
  • Turn around high-dollar and/or short-deadline cases in a timely manner.
  • Abide by all HIPAA and other compliance rules and regulations.

Requirements:

  • Bachelor's degree from a four-year college or university.
  • Licensed as a Registered Nurse (including RN, APRN, CRNP), Nurse Practitioner (including CNP, LNP, NPC), Physician Assistant, Physician, or other qualified healthcare provider.

Compensation:

  • $45+ per hour depending on candidate's qualifications.
  • Eligibility for monthly bonuses after 90 days of employment.
  • Other benefits including 401k, health insurance, disability insurance, and commuter benefits available for full-time employees.