RN Appeal Specialist

Job Summary

Reviewing and resolving insurance denials, the full-time remote RN Appeal Specialist II will analyze claims for reimbursement accuracy, collaborate with internal teams for appeal resolutions, and provide trend reporting on denials.

Key responsibilities

• Files medical necessity and level of care appeals based on established guidelines
• Monitors clinical appeal processes, identifying trends and providing feedback to relevant departments
• Tracks and manages clinical denials, ensuring compliance with documentation standards

Required qualifications

• Associate Degree in Nursing, Physical Therapy, Occupational Therapy, or Speech Therapy required
• 3-5 years of experience in clinical operations in Nursing, Physical Therapy, Occupational Therapy, or Speech Therapy required
• 1-3 years of experience in claims processing, healthcare billing, or revenue cycle management preferred
• 1-3 years of experience in utilization review and/or case management preferred
• State Licensure as an RN, PT, OT, or SLP required