Clinical Appeals Nurse
For more than 35 years, McBee Associates has focused exclusively on the financial and management needs of health care organizations across the country. McBee Associates has a proven track record of providing solutions designed to increase profitability, improve operations, and ensure the financial health of their clients.
Due to an increase in demand for our services, McBee Associates is currently seeking Clinical Appeals Nurses for our New York City office.
Clinical Appeals Nurses provide support to the Appeals Management Practice. The Clinical Appeals Nurse reviews medical records and prepares clinical appeals in response to medical necessity denials and DRG reassignments. Successful appeals will result in overturning denied claims and recovering revenue for our clients.
- Prepare professional, effective clinical appeals in response to managed care , governmental, or RAC denials for hospital clients.
- Utilize industry guidelines, Medicare Benefit Policy Manual guidelines, national coverage determinations, local coverage determinations, and best practice standards, as well as a broad knowledge base and sound clinical judgment in reviewing medical records and writing appeals.
- Participate in telephonic Administrative Law Judge Hearings and present oral arguments for reversing Medicare denials.
- Bachelors of Science degree in Nursing or equivalent
- Current state licensure
- Minimum of 3 years case management/concurrent review/utilization management experience is required
- 5+ years clinical experience in acute care setting in medical/surgical nursing, pediatric nursing, critical care, or psychiatric nursing and proficiency in medical record review
- Payer case management experience is a definite plus
- Superior written communication skills
- Proficiency with MS Word a MUST
McBee Associates is proud to offer 100% paid health and dental insurance to all of its employees, as well as a comprehensive benefits package.