West Virginia Licensed Clinical Denials Coordinator

Job Summary

Coordinating clinical denials management, the part-time West Virginia Licensed Clinical Denials Coordinator will be responsible for reporting, monitoring, and analyzing denials, as well as performing appeals writing for various payer denials while working remotely.

Key responsibilities

• Completes clinical appeal writing for insurance denials and coordinates all administrative activities related to denial management
• Evaluates patient medical records to identify discrepancies in billing and supports negotiations with external auditors
• Develops and coordinates training sessions for staff to enhance understanding of payer denial activities and process improvement initiatives

Required qualifications

• Current Registered Nurse license issued by the state or current multi-state Registered Nurse license through the enhanced Nurse Licensure Compact (eNLC)
• Three (3) years of healthcare clinical experience
• Bachelor's Degree in Nursing or Associate of Science in Nursing Degree (ASN) or Diploma; currently enrolled in a BSN program with completion within three (3) years of hire is preferred
• Experience in medical management for Medicare and/or Medicaid populations is preferred
• Utilization Management experience is preferred