Job Description
Description
The Clinical Review Specialist is responsible for proper clinical review and interpretation of medical records and claim documentation to assist with the appeals of denied insurance claims. Responsibilities include drafting appeal letters based on clinical judgment and knowledge. This is a remote position with the option to also work in the office should the candidate desire. On occasion, HLS may request with advance notice that the Clinical Review Specialist lead an in-person training or seminar with staff.
Hours
This is a part-time position with the potential to become full-time position. The position would be 15 hours per week to start with more hours potentially available depending on HLS’s workload and candidate’s availability.
Responsibilities
This is not an inclusive list. Other duties may be assigned. Familiarity with and ability to identify different types of hospital documentation including, but not limited to, medical records, UB-04s, EOBs, itemized bills, hospital account notes, appeal letters, and denial/approval letters.
Required Qualifications
Bachelor's degree from four-year college or university. The Clinical Review Specialist should be licensed as a Registered Nurse (including RN, APRN, CRNP), Nurse Practitioner (including CNP, LNP, NPC), Physician Assistant, Physician, or other qualified healthcare provider. Current active licensure is not required.
Compensation
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