New York Licensed Clinical Denial Specialist
Job Summary
To support organizational reimbursement efforts, the full-time remote New York Licensed Clinical Denial Specialist will manage the review, appeal, and resolution of DRG-related payer denials while ensuring compliance with regulatory requirements and enhancing revenue integrity.
Key responsibilities:
- Ensures accurate and timely resolution of DRG-related payer denials to minimize revenue loss
- Produces compliant appeal outcomes by applying clinical, coding, and payer policy knowledge to disputed DRG determinations
- Analyzes denial trends and appeal outcomes to improve processes and support denial prevention strategies
Required qualifications:
- Degree in Nursing
- NYS Registered Nurse Licensure
- AS in Health Information Management
Complete Job Description
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