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Case Appeals Nurse
The Case Appeals Nurse manages the process of appealing clinical denials and reviewing denials to the insurance provider. RESPONSIBILITIES: Must have a good understanding of reimbursement methodologies and terms. Must have demonstrated knowledge of industry trends in Managed Care. Work requires familiarity working with contracts and payment rules. Must have demonstrated expertise in insurance, managed care and federal/ state coverage. Work requires a high level of problem solving skills. Must have working knowledge of utilization management, case management and process improvement. Must have base knowledge of clinical coding and reimbursement and/or claims management. Must h


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