Oregon Licensed Clinical Appeals Specialist

Job Summary

Managing clinical denials remotely, the full-time Oregon Licensed Clinical Appeals Specialist will conduct comprehensive reviews of clinical documentation, formulate timely responses based on medical necessity criteria, and communicate denial trends to leadership while improving the appeals process.

Key responsibilities

• Conduct comprehensive reviews of clinical documentation to manage clinical denials
• Formulate timely and defensible written responses based on evidence-based medical necessity criteria
• Communicate identified denial trends and patterns to relevant patient accounting leaders

Required qualifications

• 3 years of clinical RN experience, including 1 year in Denial Management or Case Management
• Experience with reimbursement methodologies
• Bachelor's degree in Nursing or an allied health field (preferred)
• Registered Nurse License by the Oregon State Board of Nursing is required
• Certified Clinical Documentation Integrity Specialist (CCDS) or Certified Case Manager (CCM) (preferred)