Health Advocates is seeking a Clinical Appeals Nurse for our main office in Chatsworth, CA. Job Summary Reviews medical records and performs clinical reviews to overturn insurance claim clinical denials. Job responsibilities: reviews hospital claim denials, determines the basis for appeals using standardized medical review criteria/software (including related to Medi-Cal, Medicare, and Commercial payer sources), completes medical record analysis and abstraction, utilizes standardized and ad hoc letters for appeals, and performs miscellaneous related duties, as needed.
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