Registered Nurse Clinical Denials Specialist

A company is looking for a Clinical Denials Specialist to manage claim denials related to referrals, authorizations, and medical necessity. Key Responsibilities Research and analyze assigned payer denials and prepare professional appeal letters Prepare reports for management review and identify trends in denial and appeal outcomes Ensure compliance with federal, state, and payer regulations regarding denial management activities Required Qualifications, Training, and Education Associate's Degree in a business or healthcare related field Registered Nurse (RN) Certification with relevant experience Experience with Electronic Health Record platforms (e.g., Epic, Cerner, Meditech) Knowledge of various insurance payers is preferred Proficient PC skills and ability to type 30-40 wpm

Apr 7, 2025 - 21:40

A company is looking for a Clinical Denials Specialist to manage claim denials related to referrals, authorizations, and medical necessity. Key Responsibilities Research and analyze assigned payer denials and prepare professional appeal letters Prepare reports for management review and identify trends in denial and appeal outcomes Ensure compliance with federal, state, and payer regulations regarding denial management activities Required Qualifications, Training, and Education Associate's Degree in a business or healthcare related field Registered Nurse (RN) Certification with relevant experience Experience with Electronic Health Record platforms (e.g., Epic, Cerner, Meditech) Knowledge of various insurance payers is preferred Proficient PC skills and ability to type 30-40 wpm