Appeals Nurse - Anesthesia Denials Management

150 Shriners Hospitals for Children; United States; On-site; USD 81,000 - 121,000; Full time

Benefits offered by this job

Medical, dental, and vision insurance

Tuition assistance

Retirement matching

Job summary

Shriners Children’s is seeking a Denials Management Appeals Nurse (Anesthesia) to review clinical documentation and determine appeal viability. The role requires experienced anesthesia background, utilization review, and payer-specific knowledge across Third Party and governmental payors.

You will file compliant appeals and maintain detailed case status across facilities in the U.S. Strong regulatory understanding, RN licensure, and 5+ years in healthcare are expected, with BSN preferred.

Qualifications

• Minimum 5 years of clinical healthcare/hospital experience with 3 years in anesthesia.
• Experience with Third Party Payor Appeals/Revenue Cycle.
• RN license active in the state of employment.
• Experience with Utilization Review and knowledge of regulatory bodies.
• Bachelor’s degree (BSN) preferred.

Responsibilities

• Review assigned cases by comparing the bill to the medical record.
• Detailedly compare charges to documentation to ensure accurate charge capture.
• Communicate findings with hospital staff and obtain agreement on discrepancies.
• Follows up on appeals to ensure timely completion.
• File appeals based on medical necessity guidelines or InterQual criteria.

Skills

Utilization review

Regulatory knowledge

Staff communication

Education

RN license (state)

High School Diploma

BSN preferred

Tools

Epic

Craneware

Waystar

Job description

Shriners Children’s is seeking a Denials Management Appeals Nurse (Anesthesia) to review clinical documentation and determine appeal viability. The role requires experienced anesthesia background, utilization review, and payer-specific knowledge across Third Party and governmental payors.

You will file compliant appeals and maintain detailed case status across facilities in the U.S. Strong regulatory understanding, RN licensure, and 5+ years in healthcare are expected, with BSN preferred.