Clinical Denial Specialist

Job Summary

To manage claim denials effectively, the full-time Clinical Denial Specialist will review and submit appeals related to referrals, authorizations, and medical necessity while working remotely and adhering to compliance regulations.

Key responsibilities

• Research and analyze assigned payer denials, including referral and authorization issues
• Independently write and submit professional appeal letters in accordance with payer policies
• Prepare reports to identify trends and monitor denial and appeal outcomes for management review

Required qualifications

• Associate's Degree in a business or healthcare-related field
• Registered Nurse (RN) Certification with experience in care management and appeals
• Experience with Electronic Health Records (EHR) platforms such as Epic, Cerner, or Meditech
• Knowledge of various insurance payers is preferred
• Proficient PC skills with the ability to type 30-40 words per minute