Clinical Denials & Appeals Specialist

Atlas-Healthcare-Partners-LLC; Phoenix (AZ); On-site; USD 74,000 - 109,000; Full time

Benefits offered by this job

Health and dental benefits

Retirement package

Job summary

Atlas Healthcare Partners seeks a Specialist – Clinical Review to analyze and appeal denied Ambulatory Surgery Center claims. You will collaborate with physicians, coding, billing, and operations to maximize reimbursement and reduce denials.

The role requires RN licensure, 2+ years in denials review, 3+ years in revenue cycle, and knowledge of Medicare/Medicaid payer rules. Work location is flexible within the U.S. ASC environment with compliance and HIPAA obligations.

Qualifications

• Associate’s Degree or Diploma in Nursing required; RN license in state of practice.
• Minimum 2 years of experience reviewing and appealing medical necessity denials.
• Minimum 3 years of healthcare revenue cycle, utilization review, case management, or denial management experience.
• Experience with Ambulatory Surgery Centers, hospital outpatient departments, or surgical specialties preferred.
• Knowledge of Medicare, Medicaid, and commercial payer requirements.

Responsibilities

• Review denied ASC claims to determine root cause and appeal opportunities.
• Analyze payer denial rationale related to medical necessity, prior authorization, and level of care.
• Conduct clinical reviews of patient records, operative reports, and documentation.
• Prepare and submit quality clinical appeal letters with supporting documentation.
• Manage first- to external review appeals and track status within deadlines.
• Identify denial trends and recommend corrective actions.

Education

Associate’s Degree or Diploma in Nursing

RN license in state of practice

Compact RN licensure

Experience in healthcare revenue cycle

Job description

Atlas Healthcare Partners seeks a Specialist – Clinical Review to analyze and appeal denied Ambulatory Surgery Center claims. You will collaborate with physicians, coding, billing, and operations to maximize reimbursement and reduce denials.

The role requires RN licensure, 2+ years in denials review, 3+ years in revenue cycle, and knowledge of Medicare/Medicaid payer rules. Work location is flexible within the U.S. ASC environment with compliance and HIPAA obligations.