Clinical Denials & Appeals Specialist

1103 Team Member Services; United States; Sur place; USD 71 000 - 133 000; Plein temps

Avantages offerts par ce poste

Medical

Dental

Vision Insurance

Life Insurance

Disability Insurance

Paid Time Off from Day One

403-B Retirement Plan

Parental Leave (4 weeks)

Career Development

Well-being Resources

Mental Health Resources and Support

Pet Benefits

Résumé du poste

AdventHealth in Altamonte Springs, FL is seeking a Registered Nurse with expertise in clinical denial appeals and revenue integrity to review denials across the system. You will research payer policies, charge histories, and clinical documentation to craft compelling appeals and collaborate with multiple departments to obtain necessary information.

The role requires strong knowledge of CPT/HCPCS/ICD coding, utilization review, and effective written communication.

Qualifications

• RN required and registered.

Responsabilités

• Review and appeal denials for clinical services across the system.
• Research payer policies, charge histories, and clinical documentation to support appeals.
• Collaborate with pre-access, patient financial services, and clinical staff.
• Provide training on denial trends and remediation as needed.
• Defend and appeal denied claims through written and verbal communication.

Connaissances

CPT/HCPCS/ICD understanding

Revenue integrity

Denial management

Clinical documentation

Utilization review

MS Office proficiency

Team collaboration

EMR navigation

Formation

Bachelor's degree

Master's degree

Field: nursing/management/business

Outils

EMR systems

Microsoft Office (Word/Excel/Outlook)

Description du poste

AdventHealth in Altamonte Springs, FL is seeking a Registered Nurse with expertise in clinical denial appeals and revenue integrity to review denials across the system. You will research payer policies, charge histories, and clinical documentation to craft compelling appeals and collaborate with multiple departments to obtain necessary information.

The role requires strong knowledge of CPT/HCPCS/ICD coding, utilization review, and effective written communication.