Senior Denials RN Specialist

Overview

Employer Industry: Revenue Cycle Management Solutions

• Prepare appeals for clinical and technical claim denials across all client hospital facilities
• Review medical records for medical necessity criteria and file written letters of appeal on denied claims
• Analyze claim denials and underpayments to determine potential additional payment amounts
• Collaborate with the Clinical Denial team and Case Management Department to communicate denial trends
• Mentor and provide training to Clinical Denial and Underpayment team members

• Must hold a Registered Nurse (RN) license
• 5 to 7 years of relevant experience in revenue cycle management or related fields
• Knowledge of ERISA compliance laws and healthcare provider/member legal rights regarding appeals
• Must pass a typing test of 45 words per minute (error adjusted)
• Demonstrated ability to meet productivity and quality assurance standards

• 4-year Bachelor's Degree
• 2 years of experience in denials, utilization review, or case management
• 5+ years of experience in revenue cycle, legal nurse consulting, or chart audit/review
• Strong background in provider relations
• Internal candidates must have met 100% productivity and quality assurance in the previous 3 months

#Revenue Cycle Management  #Healthcare Jobs #Career Opportunity #Remote Work #Professional Development

We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately.

We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.