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Nurse Manager, Operations - Duke Raleigh Hospital - Inpatient Medical Oncology Unit 5200 - Full Time
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RN Clinical Appeals Coordinator - M-F, Dayshift - Remote Work Available
PRIMARY FUNCTION:The RN Clinical Appeals Coordinator will partner with physician advisors to ensure medically necessary inpatient denials are appealed, as appropriate, to ensure optimal reimbursement and trend appeals outcome data. PRINCIPAL DUTIES AND RESPONSIBILITIES:Optimize appeal outcomes of Medicare Advantage, Commercial and Medicaid plans via all available appeal options including, but not limited to peer to peer appeals, secondary appeals, and involvement with IROs Evaluate and understand inpatient medical necessity appeal options for all federal and commercial payers Interpret Medical Director notes and summarize into correspondence for provider and/or facility.Review first and second level appeals for medical necess
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