Clinical Denials Specialist

Job Summary

Working remotely, the Clinical Denials Specialist will review denied claims, analyze denial reasons, and collaborate with healthcare providers to gather documentation for appeals, ensuring accurate reimbursement for healthcare services.

Key responsibilities

• Review denied claims to identify denial reasons and discrepancies
• Analyze medical records and payer policies to prepare effective appeal arguments
• Monitor denial trends and provide feedback to revenue cycle teams to improve processes

Required qualifications

• Bachelor's degree in healthcare administration, nursing, health information management, or a related field
• Clinical designated nurse or RN credentials (denials/CDI)
• Minimum of 2-3 years of experience in healthcare revenue cycle management, medical billing, claims processing, or denial management