Clinical Appeal Specialist

CO1000 H. Lee Moffitt Cancer Center and Research Institute Hospital, Inc.; United States; On-site; USD 44,000 - 67,000; Full time

Job summary

Moffitt Cancer Center in Florida is seeking a Denials Review Specialist to coordinate denials review, appeals, and recovery processes in our Florida-based team. The role emphasizes accurate documentation, timely responses, and collaboration with care teams to optimize reimbursement.

The ideal candidate has strong analytical skills, experience with Medicare/Medicaid policies, and proficient MS Excel capabilities, with a focus on accuracy and regulatory compliance.

Qualifications

• Associate's degree or higher in healthcare, finance, or related field.
• Bachelor's degree plus 5 years healthcare experience and RN license required, or associates degree with 7 years experience.
• Experience with denials, appeals, and reimbursement processes preferred.
• Strong knowledge of Medicare/Medicaid regulations and coding concepts.
• Proficient in MS Office, especially Excel and Access.

Responsibilities

• Coordinate denials review and appeals management processes.
• Oversee denials management, claims recovery, and denial root cause analysis.
• Collaborate with care teams to optimize reimbursement and payment accuracy.
• Maintain documentation and ensure regulatory compliance.

Skills

denials management

claims recovery

root cause analysis

data analysis

communication

teamwork

attention to detail

reporting

Education

Bachelor's degree

Associates degree

RN license

Tools

Soarian

MS Excel

MS Access

Job description

Working at Moffitt is both a career and a mission: to contribute to the prevention and cure of cancer. As the only National Cancer Institute-designated Comprehensive Cancer Center based in Florida, Moffitt employs some of the best and brightest minds from around the world. Join a dedicated team of nearly 11,000 who are shaping the future we envision. Moffitt has been recognized as a Best and Brightest Company to Work For in the Nation and is continually named one of the Tampa Bay Times’ Top Workplaces.

Summary

Responsible for the administration and coordination of the denials review and appeals management processes that includes denials management, claims recovery, and denial root cause analysis.

Minimum Required

Associate's Degree in Healthcare, Finance, or other related field * "in lieu of" Bachelor's please review Experience, minimum required below.

Minimum Experience/Certification Required

Bachelors Degree plus a minimum of five (5) years healthcare experience and RN required (OR) "in lieu of" a Bachelor's degree you must have an Associates degree plus a seven (7) years healthcare experience preferably in Nursing RN license required.

Accommodation

**Accommodation: LPN's currently in the role of Clinical Denial Specialist will be given a specified time frame (2 years) to obtain the RN licensure

Additional Skills/ Specialized Training Required

• Computer literate, knowledge of financial data analysis, Medicare and Medicaid regulations, third party reimbursement, and charging and coding guidelines.
• Intermediate Excel skills.
• Excellent communication skills both written and verbal

Job Related Skills

• Proficient in all aspects of reimbursement.
• Proficient in all aspects of reimbursement (i.e., benefit investigations, payer reimbursement policies, regulatory and administrative rules).
• Knowledge of managed care industry including payer structures, administrative rules, and government payers
• Adept in hospital and insurance reimbursement and billing concepts and procedures, as well as laws and regulations affecting payment compliance, denials and appeals recovery.
• Proficiency with various reimbursement methodologies including, but not limited to, Per-Diem, DRG, fee schedule, percentage of charges, and stop loss.
• Proficient understanding of medical coding systems effecting the adjudication of claims payment. These include ICD-9, CPT, HCPCS, DRG, APG, APC, and revenue code structures.
• Proficiently utilizes MS Office applications, including MS Excel and MS Access

Soft Skills

• Ability to work collaboratively in a team environment or independently, as applicable.
• Must be able to anticipate obstacles to a goal and initiates appropriate resolution.
• Must have initiative to identify barriers and opportunities and provides solutions through process and operational improvements.
• Requires investigation and analytical skills with a proven ability to communicate effectively in both written and verbal format.
• Able to communicate (both written and verbal) professionally and effectively.
• Requires exceptional attention to detail and demonstrated ability to prioritize work to ensure accuracy and timely completion.

Preferred

Experience in oncology nursing, utilization review, quality management, and/or recent case management Soarian experience

Salary Range

Salary Range $31.99 - $48.80

Salary ranges posted for this position represent the expected base pay range for the role. Actual compensation may vary based on location and a variety of job-related factors, including experience, skills, education, and internal equity among Team Members in similar positions. We are committed to maintaining fair and equitable pay practices and regularly review compensation to ensure alignment across our workforce.

Equal Employment Opportunity

Moffitt Cancer Center is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, or protected veteran or disabled status. We seek candidates whose skills, and personal and professional experience, have prepared them to contribute to our commitment to diversity and excellence.

Reasonable Accommodation

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