Clinical Denials & Appeals Specialist

Atlas Healthcare Partners; Phoenix (AZ); On-site; USD 70,000 - 100,000; Full time

Benefits offered by this job

Health and dental benefits

Matching retirement plan

Job summary

Atlas Healthcare Partners is seeking a Specialist - Clinical Review to analyze and appeal denied ASC claims, focusing on medical necessity, authorization, and documentation. You will collaborate with physicians and revenue cycle teams to strengthen clinical appeal arguments and maximize reimbursement.

The role emphasizes regulatory compliance, with responsibilities spanning evidence collection, payer communication, and comprehensive denial management to reduce avoidable denials.

Qualifications

• Associate's Degree or Diploma in Nursing required; RN license in state of practice.
• Minimum 2 years reviewing and appealing medical necessity denials.
• Minimum 3 years healthcare revenue cycle, utilization, or denial management experience.

Responsibilities

• Review denied ASC claims to determine root cause and appeal opportunities.
• Analyze payer denial rationale related to medical necessity, authorization, level of care.
• Prepare and submit clinical appeal letters with supporting documentation.
• Track appeal status and meet payer deadlines.
• Maintain HIPAA confidentiality and compliance.

Skills

Denial review

Appeals management

Revenue cycle knowledge

HIPAA compliance

Clinical collaboration

Education

Associates degree in Nursing

RN license in state of practice

Tools

Practice management system

EHR systems

Coding software

Job description

Atlas Healthcare Partners is seeking a Specialist - Clinical Review to analyze and appeal denied ASC claims, focusing on medical necessity, authorization, and documentation. You will collaborate with physicians and revenue cycle teams to strengthen clinical appeal arguments and maximize reimbursement.

The role emphasizes regulatory compliance, with responsibilities spanning evidence collection, payer communication, and comprehensive denial management to reduce avoidable denials.