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, all while working remotely during standard business hours.

Key responsibilities:

• Provide clinical expertise in the appeals and denial management process to achieve significant savings for the organization
• Evaluate and intervene in retrospective coverage issues and denial compliance to ensure accuracy in billing and coding
• 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
• A minimum of 5 years of clinical nursing experience, preferably in Case Management or Utilization Review
• Experience in federal, state, and commercial reimbursement processes
• Proficiency in auditing DRG coding and reimbursement methodologies
• Strong skills in using office desktop software programs