Tennessee Licensed Clinical Appeals Specialist

Job Summary

A company is looking for a Specialist, Clinical Appeals.

Key Responsibilities

• Perform comprehensive reviews of denied claims and conduct thorough analysis of medical records to build clinical cases for appeal
• Independently write and submit persuasive appeal letters while leveraging AI tools for efficiency
• Collaborate with team members to identify denial trends and assist in creating standardized appeal templates

Required Qualifications, Training, and Education

• Active and unrestricted Registered Nurse (RN) license
• Bachelor of Science in Nursing (BSN) preferred
• 2-3 years of clinical experience in a hospital or healthcare setting
• Previous experience in denial management or clinical appeals role
• Familiarity with medical billing, coding principles, and payer reimbursement methodologies