Clinical Appeals Specialist
3 days ago
Piper Companies is seeking a highly skilled Clinical Appeals Specialist to join their team and work remotely for a leading health insurance organization. As a Clinical Appeals Specialist, you will play a critical role in analyzing, reviewing, and submitting complex appeals to ensure member satisfaction.
Key Responsibilities:
• Assess and review non-routine appeals and grievances to ensure timely and accurate resolution
• Collaborate with non-clinical staff to provide clinical expertise and support
• Coordinate appeals process activities to ensure compliance and efficiency
• Perform accurate and complete work in a timely and efficient manner
• Report to the Manager, Nurse Lead/Team Leader, and Medical Lead
Requirements:
• 3+ years of inpatient care experience in ER, med/surg, critical care, ICU, or step-down units
• Experience with EMR/EHR Systems
• RN or LPN licensure in North Carolina
• Associate degree or higher required
Preferred Locations:
NC, AL, AZ, AR, CO, FL, GA, ID, IN, IA, KS, KY, LA, MD, MI, MS, MO, OH, OK, PA, SC, SD, TN, TX, UT, VA, WI, WY
Compensation:
• Salary Range: $38-41/hr based on relative experience
• Comprehensive Benefits: Medical, Dental, Vision, 401k
Keywords: Clinical Appeals Specialist, health insurance, RN, LPN, NC, EMR, NCDOI, NCQA, pharmaceutical companies, healthcare, complex appeals, claims, analysis, research
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