Clinical Appeals Specialist

Healthcare Legal Solutions LLC; Washington (District of Columbia); On-site; USD 75,000 - 110,000; Full time

Job summary

Healthcare Legal Solutions LLC is seeking a clinician reviewer to interpret medical records and claim documents to support appeals of denied insurance claims. You will draft and revise appeal letters based on clinical judgment, ensuring proper formats, attachments, and citations.

The role requires RN/NP/PA credentials with knowledge of HIPAA and healthcare documentation. You will also help train staff and contribute to materials development, working under management guidance.

Qualifications

• Bachelor's degree or 1–2 years of related experience or equivalent combination.
• Licensed as a Registered Nurse (RN/APRNR/CRNP) or Physician Assistant/Physician or other qualified provider.
• Knowledge of health care documentation, HIPAA, and data systems.

Responsibilities

• Review and interpret medical records and claim documents to support appeals.
• Draft, review, and revise appeal letters for denied claims.
• Ensure correct formats, guidelines, and attachments are included.
• Turn around high-dollar or short-deadline cases promptly.
• Comply with HIPAA and related regulations.
• Assist in clinical training materials and staff training.

Skills

Clinical knowledge

HIPAA knowledge

Data systems

Report writing

Staff training

Education

Bachelor's Degree in Nursing

Job description

Healthcare Legal Solutions LLC is seeking a clinician reviewer to interpret medical records and claim documents to support appeals of denied insurance claims. You will draft and revise appeal letters based on clinical judgment, ensuring proper formats, attachments, and citations.

The role requires RN/NP/PA credentials with knowledge of HIPAA and healthcare documentation. You will also help train staff and contribute to materials development, working under management guidance.