Registered Nurse Clinical Appeals Specialist

Job Summary

A company is looking for a Specialist, Clinical Appeals.

Key Responsibilities

• Perform comprehensive reviews of denied claims, focusing on clinical issues and building robust clinical cases for appeal
• Independently write and submit professional appeal letters, ensuring accuracy and adherence to payer-specific timelines
• Collaborate with team members to identify denial trends and improve appeal processes, including maintaining standardized templates

Required Qualifications, Training, and Education

• Active and unrestricted Registered Nurse (RN) license
• Bachelor of Science in Nursing (BSN) preferred
• Previous experience in denial management or clinical appeals role
• Minimum of 2-3 years of clinical experience in a hospital or healthcare setting
• Experience with EHR/EMR systems and familiarity with medical billing and coding principles