Clinical Appeals Nurse

Job Summary

Working remotely in a full-time capacity, the Clinical Appeals Nurse will review payor denials, write comprehensive appeal arguments, and liaise with third-party payors to facilitate claims appeals while monitoring revenue trends.

Key responsibilities

• Create appeal letters based on medical policy guidelines and hospital documentation
• Investigate and coordinate patient records for precertification and appeals of insurance denials
• Contact insurance companies to conduct appeals and ensure compliance with regulatory requirements

Required qualifications

• Registered Nurse (RN) license required
• Experience in clinical appeals or medical billing preferred
• Knowledge of medical necessity criteria and insurance processes
• Strong analytical skills for reviewing claim documentation
• Ability to work independently in a remote environment