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 manage assigned payer denials and prepare professional appeal letters
• Prepare reports for management, identifying trends and opportunities for process improvement
• Monitor denial and appeal outcomes, ensuring compliance with regulations and reporting findings to management

Required Qualifications

• Associate's Degree in a business or healthcare-related field
• Registered Nurse (RN) Certification with relevant experience
• Experience with Electronic Health Records (EHR) platforms
• Knowledge of various insurance payers preferred
• Proficient PC knowledge and ability to type 30-40 wpm