Appeals Nurse Cover Letter

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

In the previous role, I was responsible for feedback to members of the healthcare team (health information management (HIM), case management, PFS, etc.) regarding charging, documentation, patient status and coding issues so changes can be made to prevent future revenue risk.

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

• Requires an active, unrestricted RN License for the state of Florida
• Experience in Medicare/Medicaid grievances and appeals preferred
• Experience with precertification processes and payor sources preferred
• Registered Health Information Technician preferred
• Certified Denials Recovery Specialist preferred
• Certified Patient Account Manager preferred
• Current Maryland RN licensure
• Certification in case management desirable, but not mandatory

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

In my previous role, I was responsible for front-line support and supervision to the Utilization Review staff to focus on initial and continued stay utilization review and denials to include assessment of medical records for appropriateness, level of care provided, including assessment of treatment modalities, medications, services and application of treatment protocols.

Please consider my experience and qualifications for this position:

• Knowledge of NCQA, CMS, DOL, ERISA and other regulatory body rule preferred
• Computer skills including Windows and Microsoft Word
• Experience with Medicaid in Managed Care or Health Insurance industry preferred
• Previous Utilization Management or Appeals experience is preferred
• Understanding of the revenue cycle and the responsibility and goals of each area, how they impact the revenue cycle
• Extensive analysis of all related inquiries, claims, utilization management (UM) and case management (CM) notes the member’s benefits
• Utilize multiple systems in order to appropriately research and document the substance of the appeals
• Creation of detail, member and provider specific individualized appeal response letters

In response to your job posting for appeals nurse, I am including this letter and my resume for your review.

In the previous role, I was responsible for support for administrative denial management team to facilitate flow of information and receipt of denials and medical records.

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

• Previous experience as RN Case Manager / Utilization Review
• Unrestricted RN Licensure
• Hospital experience (Acute care)
• Knowledge of California HMO plans
• Requires experience with MS Office products
• Active, unrestricted RN license in the state of Minnesota
• Experience applying criteria for medical necessity
• Critical Care (ER/ICU) experience very helpful

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

In my previous role, I was responsible for education and leadership to physicians, nurses, discharge planners and utilization review specialists on a variety of issues around utilization and quality of care.

Please consider my qualifications and experience:

• Requires an LVN/LPN
• Working knowledge of InterQual criteria and its application
• Registered Nurse (RN) with current Michigan licensure
• Demonstrated knowledge of the InterQual® or Milliman Care Guidelines® criteria
• Knowledge of Medicare, Medicaid and NCQA guidelines and use of CMS website for research
• Knowledge of use of Microsoft Office Suite
• Knowledge of ICD-10 and CPT coding, medical necessity criteria and medical terminology
• Knowledge of inpatient and outpatient procedures and practices

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

In the previous role, I was responsible for clinical support for performing clinical review of appeals, and may also review quality of service issues.

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:

• Interact effectively with support areas, such as UM, CM, Operational Areas, Pharmacy Management other areas as applicable
• Provide excellent customer service to members, providers, and CMS
• Performs in-depth research and review of complex cases, and makes a decision
• Refers the appeal case to Member Appeals Manager and/or Medical Director as appropriate
• Recommending options and/or solutions to difficult cases or referrals for review
• Collaborates with the Member Appeals and Grievance Associates, Analysts, and Department Business Analysts as applicable to ensure all case content is met in accordance with CMS requirements
• Ensure organization, timeliness and quality and individual medical necessity review occurs with each applicable appeal case
• Assists in conducting training as needed