Denials & Appeals Clinical Specialist (RN)

Atlantic Health; Morristown (NJ); Sur place; USD 90 000 - 130 000; Plein temps

Résumé du poste

Atlantic Health is seeking a Denials Management Nurse to lead clinical review of denied services and prepare appeal letters for payers. This role reports to the Manager of Denials and acts as a clinical expert to maximize reimbursement and minimize write-offs through collaboration with revenue cycle and clinical staff.

You will develop in-house denial workflows, analyze root causes, manage workflows, and present denial data to leadership.

Qualifications

• Active NJ RN license
• BSN preferred
• 3-5+ years of clinical experience (acute care preferred)

Responsabilités

• Complete clinical review of denied services.
• Prepare clinical discussions and appeal letters for payers.
• Develop the denials department and in-house appeals workflows.
• Determine root cause of denials.
• Establish relationships with AHS leaders and review denials information.
• Effectively manage the department’s workflow, productivity and quality standards.
• Understand explanations of benefits from payors for non-governmental claims.
• Analyze hospital claims data to identify underpayments, denials and billing errors.
• Make billing adjustments in system based on denial outcomes.
• Submit information to payors and follow up on in-house denials.
• Manage assigned work queues (Revenue integrity and denials).
• Provide monthly denial reports to department manager, clinical departments, and case management.
• Able to work independently

Formation

Active NJ Registered Nurse (RN) license

BSN preferred

3-5+ years of clinical experience (acute care preferred)

Description du poste

Atlantic Health is seeking a Denials Management Nurse to lead clinical review of denied services and prepare appeal letters for payers. This role reports to the Manager of Denials and acts as a clinical expert to maximize reimbursement and minimize write-offs through collaboration with revenue cycle and clinical staff.

You will develop in-house denial workflows, analyze root causes, manage workflows, and present denial data to leadership.