Clinical Appeals & Audit Specialist — Hybrid

RegalCare at Greenfield; Holyoke (MA); Hybrid; USD 65,000 - 92,000; Full time

Job summary

RegalCare at Greenfield in Massachusetts seeks an Appeals Specialist (LPN, RN, or Therapist) to lead clinical appeals, audit management, and medical records oversight for our facility network. You will review clinical denials, craft compelling arguments, and interface with payers to protect reimbursement and ensure documentation compliance across MA facilities.

The role requires 2–3 years of clinical experience in skilled nursing or healthcare administration, MA licensure, and working knowledge

Qualifications

• Active MA license as RN/LPN or Therapist.
• 2–3 years clinical experience in skilled nursing or healthcare administration.
• Knowledge of Medicare Part A/B, Medicaid and managed care rules.
• Excellent written and verbal communication with strong analytics.

Responsibilities

• Appeals management: analyze denials and draft comprehensive appeals.
• Audit oversight: coordinate internal and external audits with timely responses.
• Medical records integrity: audit records for completeness and coding accuracy.
• Clinical collaboration: educate staff to improve documentation and prevent denials.
• Tracking & reporting: maintain a central system and report outcomes to leadership.

Skills

Analytical capability

Written communication

Verbal communication

Education

Massachusetts license (RN/LPN/ Therapist)

Tools

EHR systems

Job description

RegalCare at Greenfield in Massachusetts seeks an Appeals Specialist (LPN, RN, or Therapist) to lead clinical appeals, audit management, and medical records oversight for our facility network. You will review clinical denials, craft compelling arguments, and interface with payers to protect reimbursement and ensure documentation compliance across MA facilities.

The role requires 2–3 years of clinical experience in skilled nursing or healthcare administration, MA licensure, and working knowledge