Clinical Appeals Specialist II (RN/PT/OT/SLP)

Community Health Systems, Inc.; Franklin (TN); Remote; USD 55,000 - 75,000; Full time

Benefits offered by this job

Health coverage

401(k) with matching

Student loan repayment

Tuition assistance

Competitive pay

Paid time off

Job summary

Community Health Systems seeks an Appeal Specialist II to review, analyze, and resolve insurance denials, ensuring accurate reimbursement and regulatory compliance. The role collaborates with internal teams, provides feedback on facilities, and communicates payer updates to stakeholders to improve denial prevention and recovery processes.

The position involves following guidelines, maintaining thorough documentation, and contributing to safety and quality in patient accounts while supporting

Qualifications

• Associate Degree in Nursing, Physical Therapy, Occupational Therapy, or Speech Therapy required.
• Bachelor's Degree in Nursing, Physical Therapy, Occupational Therapy, or Speech Therapy preferred.
• 3-5 years of experience in clinical operations in Nursing, Physical Therapy, Occupational Therapy, or Speech Therapy required.
• 1-3 years of experience in claims processing, healthcare billing, or revenue cycle management preferred.
• 1-3 years of experience in utilization review and/or case management experience leveraging MCG or InterQual preferred.

Responsibilities

• Files medical necessity and level of care appeals using guidelines (MCG, InterQual, CMS).
• Monitors appeal processes and provides guidance to related departments.
• Tracks and manages clinical denials using current tools.
• Identifies patterns and trends in denials and communicates them to appropriate persons.
• Maintains documentation of payer resources regarding denials and appeals processes.
• Understands and applies CHS Appeal Process for denied claims.
• Ensures confidentiality per HIPAA; maintains compliance with safety and documentation standards.

Skills

Medical billing knowledge

Communication skills

Detail-oriented

Google Suite competence

Education

Associate Degree in Nursing

Bachelor's Degree preferred

Tools

Healthcare billing software

Google Suite

Job description

Community Health Systems seeks an Appeal Specialist II to review, analyze, and resolve insurance denials, ensuring accurate reimbursement and regulatory compliance. The role collaborates with internal teams, provides feedback on facilities, and communicates payer updates to stakeholders to improve denial prevention and recovery processes.

The position involves following guidelines, maintaining thorough documentation, and contributing to safety and quality in patient accounts while supporting