Clinical Denials & Appeals Specialist

AdventHealth; Florida; On-site; USD 71,000 - 133,000; Full time

Benefits offered by this job

Benefits from Day One

Paid Time Off from Day One

Retirement Plan (403-B)

Parental Leave

Job summary

AdventHealth in Altamonte Springs, FL, seeks a Registered Nurse specializing in clinical denial management and appeals to review denials across the system. You will research payer policies, coordinate with billing and clinical teams, and craft compelling appeal letters with accuracy and compliance.

Requires 3+ years RN experience in ICU/medical-surgical settings and 2+ years in utilization review; a Bachelor's degree is required and RN licensure is mandatory.

Qualifications

• Bachelor's degree required.
• RN license required.
• 1+ ICU and/or medical-surgical unit experience.
• 2+ utilization review experience.
• 3+ years as RN in acute setting.
• Proficiency with InterQual/MCG and denial management preferred.

Responsibilities

• Review and appeals denials for all clinical services across the system.
• Research payer websites and sources to determine appeal vs other action.
• Collaborate with pre-access, patient financial services, revenue integrity, utilization management, and clinical departments.
• Prepare reports and training on denial trends.
• Defend and appeal denied claims with clear clinical terms.

Skills

CPT/HCPCS/ICD knowledge

Revenue integrity

Clinical denial appeals

Utilization review

EMR navigation

Multi-tasking

MS Office (Word/Excel/Outlook)

Microsoft Teams

System setup & troubleshooting

Payer policy interpretation

Education

Bachelor's degree

Master's degree

Nursing (Field of Study)

Tools

Electronic medical records

Job description

AdventHealth in Altamonte Springs, FL, seeks a Registered Nurse specializing in clinical denial management and appeals to review denials across the system. You will research payer policies, coordinate with billing and clinical teams, and craft compelling appeal letters with accuracy and compliance.

Requires 3+ years RN experience in ICU/medical-surgical settings and 2+ years in utilization review; a Bachelor's degree is required and RN licensure is mandatory.