Registered Nurse Clinical Denials Specialist

Job Summary

A company is looking for a Clinical Denials Specialist to manage claim denials related to referrals, authorizations, and medical necessity.

Key Responsibilities

• Research and analyze assigned payer denials and prepare professional appeal letters
• Prepare reports for management review and identify trends in denial and appeal outcomes
• Ensure compliance with federal, state, and payer regulations regarding denial management activities

Required Qualifications, Training, and Education

• Associate's Degree in a business or healthcare related field
• Registered Nurse (RN) Certification with relevant experience
• Experience with Electronic Health Record platforms (e.g., Epic, Cerner, Meditech)
• Knowledge of various insurance payers is preferred
• Proficient PC skills and ability to type 30-40 wpm