Florida Licensed Clinical Denials Specialist

Job Summary

To support clinical operations, the full-time Florida Licensed Clinical Denials Specialist will review and appeal denials for clinical services, conduct account history research, and collaborate with various departments while working remotely.

Key responsibilities

• Reviews and appeals clinical service denials, conducting comprehensive research to determine appropriate actions
• Collaborates with pre-access, patient financial services, and clinical departments to gather necessary information for the appeals process
• Provides reports and training on clinical denial trends and recommends strategies for denial prevention

Required qualifications

• Bachelor's degree in nursing or a related field; Master's degree preferred
• Registered Nurse (RN) license required
• 1+ years of experience in ICU or medical surgical units, with proficiency in appeals writing
• 2+ years of utilization review or management experience using InterQual and/or MCG
• Extensive understanding of CPT, HCPCS, ICD, and revenue codes