Oregon Licensed Clinical Appeals Specialist

A company is looking for a Clinical Appeals Specialist (Patient Accounting) to manage clinical denials and improve the appeal process. Key Responsibilities Manage clinical denials by reviewing documentation and formulating responses based on medical necessity criteria Communicate denial trends and patterns to relevant patient accounting leaders Orchestrate education and performance improvement initiatives to enhance clinical quality and efficiency Required Qualifications Minimum 3 years of Clinical RN experience, including 1 year in Denial Management or Case Management Current RN license from the Oregon State Board of Nursing or a state approved for remote work Bachelor's degree in Nursing or an allied health field preferred Experience preparing appeals for clinical denials preferred Certifications such as CCDS or CCM preferred

Apr 12, 2025 - 16:53

A company is looking for a Clinical Appeals Specialist (Patient Accounting) to manage clinical denials and improve the appeal process. Key Responsibilities Manage clinical denials by reviewing documentation and formulating responses based on medical necessity criteria Communicate denial trends and patterns to relevant patient accounting leaders Orchestrate education and performance improvement initiatives to enhance clinical quality and efficiency Required Qualifications Minimum 3 years of Clinical RN experience, including 1 year in Denial Management or Case Management Current RN license from the Oregon State Board of Nursing or a state approved for remote work Bachelor's degree in Nursing or an allied health field preferred Experience preparing appeals for clinical denials preferred Certifications such as CCDS or CCM preferred