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

• Review and appeal clinical service denials, conducting thorough research to determine appropriate actions
• Collaborate with pre-access, patient financial services, and clinical departments to gather necessary information for the appeals process
• Provide reports and training on clinical denial trends and recommend strategies for denial prevention

Required qualifications

• Bachelor's degree in nursing, management, business, or a related field (Associate's Degree in Nursing required if Bachelor's is non-nursing)
• Registered Nurse (RN) license
• 1+ year of experience in ICU and/or medical surgical units or proficiency in appeals writing for hospital services
• 2+ years of utilization review/utilization management experience utilizing InterQual and/or MCG
• Strong proficiency in Microsoft Suite applications, specifically Word, Excel, and Outlook