Florida Licensed RN Denials Specialist

Job Summary

Focused on managing clinical denials, the full-time Florida Licensed RN Denials Specialist will work remotely to review and appeal clinical denials, research patient accounts, and collaborate with various departments to ensure accurate billing and documentation.

Key responsibilities

• Reviews and appeals clinical denials across all service lines system-wide
• Researches account histories and payment records to determine appropriate appeal strategies
• Provides reports and training on clinical denial trends and remediation strategies

Required qualifications

• Bachelor's degree in Nursing
• 2+ years of clinical denials or utilization management experience
• 3+ years of experience as a Registered Nurse in an acute clinical setting
• 1+ year of experience in ICU and/or Medical Surgical Unit
• Strong proficiency in appeals writing for hospital services