Registered Nurse Denial Coordinator

Job Summary

Working remotely in a full-time capacity, the Registered Nurse Denial Coordinator will manage concurrent denials prevention, evaluate denials from third-party payors, and consult with healthcare teams to formulate appeals, ensuring compliance with regulatory guidelines.

Key responsibilities

• Evaluate denials and non-certified days to determine appropriateness and feasibility of appeals
• Consult with attending physicians and case managers to develop secondary and formal appeals using medical management tools
• Review surgery cases to ensure proper documentation and billing accuracy prior to submission

Required qualifications

• Bachelor's degree in nursing or related field
• Current Registered Nurse license and one of the listed certifications (e.g., AAMCN, CCMC)
• At least 2 years of experience in hospital or payor utilization management review
• 3 years of hospital clinical experience preferred
• MCG Certification or eligibility to pursue within 90 days of hire