Idaho Licensed Clinical Denials Nurse

Job Summary

To support the revenue cycle, the remote Idaho Licensed Clinical Denials Nurse will assess clinical and financial information to resolve denials and appeals, collaborating with healthcare providers and educating staff while contributing to process improvement initiatives.

Key responsibilities

• Assess clinical and financial information to evaluate medical necessity and coverage issues
• Collaborate with case managers and payers to resolve managed care issues and denials
• Educate hospital staff on managed care and coding-related denial issues

Required qualifications

• Licensed Practical Nurse (LPN) or three years of clinical denial experience
• Degree in Nursing or Coding Certificate preferred
• Minimum of three years of experience in clinical denial management or related healthcare revenue cycle functions
• Relevant clinical or coding certification preferred
• Experience working with insurance plans, denials, and appeals preferred