California Licensed Clinical Reimbursement Specialist

Job Summary

Seeking a Senior Clinical Reimbursement Specialist, this remote position will independently manage complex pre- and post-service appeals, mentor junior team members, and drive process improvements to enhance revenue capture and overturn rates within the revenue cycle.

Key responsibilities

• Independently manage complex pre- and post-service appeals, including the development and submission of appeal documentation
• Serve as a clinical subject matter expert on payer medical policies, guiding appeal strategies for high-dollar cases
• Mentor junior Clinical Reimbursement Specialists and contribute to the development of operational tools and SOPs

Required qualifications

• Active clinical licensure (e.g., RN, NP)
• Associate or Bachelor's degree in nursing
• 3-5 years of experience in healthcare reimbursement or revenue cycle operations
• 2+ years of experience in prior authorization, denial management, or appeals
• Advanced understanding of payer medical policies and appeals processes