Arizona Licensed RN Denials Specialist

Job Summary

A company is looking for an RN Denials Management Specialist.

Key Responsibilities

• Provide clinical expertise and oversight in the denial management process and clinical appeals
• Evaluate and intervene on coverage issues, payor outliers, and denial compliance issues
• Analyze industry trends to reduce denials and improve financial outcomes for the organization

Required Qualifications

• 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
• Working knowledge of utilization management and patient services
• Proficiency in office desktop software programs