Clinical Appeals Nurse: Resolve Payor Denials

Grady Health System; Atlanta (GA); On-site; USD 85,000 - 110,000; Full time

Benefits offered by this job

Health & Wellness

Financial Security

Work-Life Balance

Career Growth

Employee Support

Job summary

Grady Health System is seeking a Clinical Appeals Nurse to evaluate payor clinical denials and downgrades, collaborating with stakeholders to prepare effective appeals. The role requires RN-level clinical experience and familiarity with utilization review criteria such as InterQual, plus strong communication skills.

The nurse will track appeal status in the Epic system, report success rates by payor, and help identify denial trends to improve revenue performance across the health system.

Qualifications

• 3+ years audit/appeals or utilization review experience.
• BS Nursing required; Registered Nurse in Georgia.
• Strong written and verbal communication; experience with Epic system and utilization criteria (InterQual).

Responsibilities

• Compose accurate clinical appeals to payors using informed clinical best practices.
• Collaborate with departments to support clean claims and prompt payment.
• Analyze denials trends with Care Management and Revenue Strategy to reduce inappropriate denials.
• Track appeals in Epic and report on payor-specific success rates.
• Perform other duties as assigned.

Skills

Audit/appeals experience

Utilization review

RN experience

Education

BS Nursing

Job description

Grady Health System is seeking a Clinical Appeals Nurse to evaluate payor clinical denials and downgrades, collaborating with stakeholders to prepare effective appeals. The role requires RN-level clinical experience and familiarity with utilization review criteria such as InterQual, plus strong communication skills.

The nurse will track appeal status in the Epic system, report success rates by payor, and help identify denial trends to improve revenue performance across the health system.