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, manage clinical appeals, and collaborate with payers to secure reimbursements in a fully remote environment.

Key responsibilities

• Provide clinical expertise in the denial management process and oversee the clinical appeals, resulting in significant savings for the organization
• Evaluate and intervene on coverage issues, payor outliers, and compliance issues related to billing and reimbursement
• Analyze industry trends to reduce denials and improve financial outcomes, making recommendations for process improvements

Required qualifications

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