Clinical Review Specialist

3 weeks ago


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

The Clinical Review Specialist 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:
  • Drafting appeal letters based on clinical judgment and knowledge
  • Examine and interpret medical records and claim documentation to appeal denied insurance claims
  • Apply clinical judgment and knowledge for medical necessity, admission, and other clinical reviews
  • Confirm that the correct letter format, guidelines, and argument were used
  • Ensure all necessary attachments are noted and included with appeal
  • 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 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

If converted to full-time, other benefits including 401k, health insurance, disability insurance, and commuter benefits are available



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