Florida Licensed Clinical Denials Specialist

Job Summary

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

Key responsibilities

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

Required qualifications

• Bachelor's degree in nursing, management, business, or related field; advanced degree preferred
• Registered Nurse (RN) license required; additional certifications such as CCM or CCDS preferred
• Minimum of 1 year of experience in ICU or medical-surgical units, with proficiency in appeals writing
• At least 2 years of experience in utilization review or related fields, utilizing InterQual and/or MCG
• Proficiency in Microsoft Suite applications and ability to navigate electronic medical records effectively