Nurse Appeals Specialist: Denials & Revenue Integrity

Southern NH Medical Center; Manchester (NH); Vor Ort; USD 65.000 - 90.000; Vollzeit

Zusammenfassung

Southern NH Medical Center in Manchester, NH seeks a Nurse Appeals Specialist to evaluate clinical documentation and develop persuasive appeal arguments. The role collaborates with clinical and revenue cycle teams to identify root causes of denials and improve revenue integrity.

Responsibilities include reviewing denials, preparing clinical summaries, communicating with payers, and guiding education to reduce future denials. Nursing background and coding experience are essential.

Qualifikationen

• Associate degree in nursing required.
• Current permanent U.S. work authorization.
• Bachelor of Science in Nursing preferred.

Aufgaben

• Review clinical denials and initiate appeals per guidelines.
• Conduct medical record reviews and prepare summaries for appeals.
• Communicate with payer representatives, counsel, and stakeholders.
• Monitor appeals and escalate to the highest level when needed.
• Assist billing and case management in reviewing high-risk accounts.

Kenntnisse

Analytical skills

Verbal and written communication

Time management

Ausbildung

Associate Degree in Nursing

Tools

Epic Coding

HIM

Revenue Integrity software

Jobbeschreibung

Southern NH Medical Center in Manchester, NH seeks a Nurse Appeals Specialist to evaluate clinical documentation and develop persuasive appeal arguments. The role collaborates with clinical and revenue cycle teams to identify root causes of denials and improve revenue integrity.

Responsibilities include reviewing denials, preparing clinical summaries, communicating with payers, and guiding education to reduce future denials. Nursing background and coding experience are essential.