Florida Licensed Clinical Appeal Specialist

Job Summary

Responsible for the administration and coordination of denials review and appeals management processes, the full-time Florida Licensed Clinical Appeal Specialist will manage claims recovery and denial root cause analysis in a remote work environment.

Key responsibilities

• Oversee the denials management process, ensuring effective appeals and claims recovery
• Conduct root cause analysis for denials to identify and implement corrective actions
• Collaborate with healthcare teams to enhance reimbursement processes and compliance

Required qualifications

• Associate's Degree in Healthcare, Finance, or a related field; Bachelor's Degree preferred
• RN license required, with five years of healthcare experience or seven years with an Associate's Degree
• Proficient in reimbursement methodologies and medical coding systems
• Intermediate skills in Excel and knowledge of Medicare and Medicaid regulations
• Experience in oncology nursing, utilization review, or case management is preferred