Arizona Licensed RN Denial Specialist

Job Summary

To support the denial management process, the full-time Arizona Licensed RN Denial Specialist will analyze medical records, craft clinical appeals, and collaborate with payers to secure reimbursement while working remotely during standard business hours.

Key responsibilities

• Provide clinical expertise and oversight in the denial management process, including responding to audit requests and preparing appeals
• Evaluate coverage issues, payor outliers, and compliance issues to ensure accurate billing and reduce denials
• Quantify and analyze industry trends to recommend improvements that enhance financial outcomes for the organization

Required qualifications

• Active Registered Nurse (R.N.) licensure in the state of practice
• A minimum of 5 years of clinical nursing experience, preferably in Case Management or Utilization Review
• Experience with federal, state, and commercial reimbursement processes and auditing DRG coding
• Proficiency in office desktop software programs
• Strong critical thinking and problem-solving skills