Clinical Appeals Lead — Payer Denials & Reimbursement

Orthofix Holdings, Inc.; Carlsbad (CA); Vor Ort; USD 122.000 - 149.000; Vollzeit

Zusammenfassung

Orthofix Holdings, Inc. in California seeks a licensed RN or LVN to lead the clinical appeals workflow, ensuring timely submissions and compliant processes. You will review denials, draft patient-specific narratives, and collaborate across departments to strengthen documentation and policy alignment.

This in-office role requires CA residency, with travel as needed, and offers a competitive salary. You will contribute to revenue preservation while supporting payer strategies and audit readiness.

Qualifikationen

• Active, unrestricted license as RN or LVN in California.
• Minimum six years of experience in clinical appeals, denials, reimbursement, or related field.
• Experience reviewing medical records and payer criteria.
• Ability to write persuasive clinical appeal narratives.
• Proficiency with MS Word, Excel, PowerPoint, and case tracking tools.

Aufgaben

• Lead daily clinical appeals workflow, intake, denial classification, and submission.
• Perform licensed clinical review of payer denials and determine appeal pathway.
• Create patient-specific appeal narratives connecting records, policies and medical necessity.
• Maintain standardized templates, checklists, dashboards, and quality controls.
• Collaborate with cross-functional teams to improve readiness and timelines.

Kenntnisse

Licensed RN/LVN CA

Clinical appeals

Documentation accuracy

MS Word/Excel/PowerPoint

Office-based work in CA

Ausbildung

RN or LVN license in CA

Nursing program graduate

Tools

Microsoft Word

Excel

PowerPoint

Outlook

Jobbeschreibung

Orthofix Holdings, Inc. in California seeks a licensed RN or LVN to lead the clinical appeals workflow, ensuring timely submissions and compliant processes. You will review denials, draft patient-specific narratives, and collaborate across departments to strengthen documentation and policy alignment.

This in-office role requires CA residency, with travel as needed, and offers a competitive salary. You will contribute to revenue preservation while supporting payer strategies and audit readiness.