Clinical Appeals RN Cover Letter

I submit this application to express my sincere interest in the clinical appeals RN position.

In the previous role, I was responsible for updates on CMS changes and AMA / CPT changes and ensure implementation, as well as attending annual AMA code update meeting to understand all coding changes.

Please consider my experience and qualifications for this position:

• Previous Utilization Review experience is preferred
• Experience with InterQual system preferred
• HHA and / or PCA experience
• Experience with prior authorization, utilization management or clinical appeal review
• Medicaid population
• Reside in a nurse compact licensure state
• Preferred location 1101 Greenwood Avenue location, Lake Mary, Florida
• Demonstrated understanding of Utilization Review Guidelines (NYS ART 44 and 49 PHL), InterQual, Milliman or Medicare local coverage guidelines

I am excited to be applying for the position of clinical appeals RN. Please accept this letter and the attached resume as my interest in this position.

Previously, I was responsible for support to all units within CR&R to ensure Star Ratings are not jeopardized and all clinical components are met for CMS, NCQA, URAC, DOL, DOI, and all other State and Federal entities.

Please consider my qualifications and experience:

• Critical thinking, astute assessment and confident in decision making
• Knowledge of Interqual, MCG, or equivalent criteria and reimbursement guidelines
• Use of Microsoft Office including Word, Excel, and Power Point
• Use of EPIC
• Experience dealing with coding and claim edits
• Registered Nurse with active RN license in State of PA
• Organized and demonstrates excellent team management skills
• Claim review processes and workflow

I would like to submit my application for the clinical appeals RN opening. Please accept this letter and the attached resume.

In my previous role, I was responsible for education to all appropriate staff to insure compliance with the regulations and protocols for MDS 3.0 accuracy in coding, CMS updates and relevant changes.

I reviewed the requirements of the job opening and I believe my candidacy is an excellent fit for this position. Some of the key requirements that I have extensive experience with include:

• Intermediate Other Knowledge and proficiency in utilization criteria such as Interqual, MCG (Millimen), CPG
• Knowledge of medical terminology, Current Procedural Terminology (CPT), and International Classification ofDisease (ICD)
• Experience with Northern Light Health patient accounting software is preferred
• Assist in maintaining a work environment free from recognized hazards that create a risk or injury to employees, patients, or visitors
• Ergonomic evaluations are completed as needed
• When appropriate, assist and support with the return of all workers with work related injuries and illness to gainful employment
• North Carolina residency
• Billing and Coding experience

I would like to submit my application for the clinical appeals RN opening. Please accept this letter and the attached resume.

Previously, I was responsible for knowledge and expertise related to third party government and non~government payer clinical denials and appeals processes.

Please consider my experience and qualifications for this position:

• CPC or another Clinical Coding certification
• Previous experience with InterQual system
• Location – Phoenix
• Current, unrestricted REGISTERED NURSE (RN) license in the State of CALIFORNIA (regardless of residency)
• Appeals experience is strongly preferred
• CPT, HCPC, ICD-9 and ICD-10 coding experience is strongly preferred
• Previous experience in a telephonic or office based role
• Maintains a positive attitude in a fast-paced environment

Please consider me for the clinical appeals RN opportunity. I am including my resume that lists my qualifications and experience.

In my previous role, I was responsible for position-specific training on ICD-10 coding and Risk Adjustment Methodology for staff members at the onset of the hiring process.

My experience is an excellent fit for the list of requirements in this job:

• Clinical criteria and medical policy
• Group process and team dynamics
• Center for Medicare and Medicaid Services (CMS)
• Interpersonal, verbal, and written communication
• Independent & critical thinking
• Microsoft Office (Word, Excel, Outlook) – Basic
• Certified Professional Coder (CPC) and/or Certified Professional Coder – Hospital (CPH)
• Prior experience as a pre-service or post-service clinical reviewer