Registered Nurse - Clinical Appeals Specialist

Cognizant Technology Solutions Corporation; United States; Remote; USD 70,000 - 90,000; Full time

Job summary

A well-known healthcare company is seeking a Registered Nurse - Clinical Appeals & Denials Specialist to work remotely. In this role, you will manage clinical denial cases, draft medical necessity determinations, and document relevant claims information. The ideal candidate has an RN educational background and experience in utilization management and healthcare revenue cycles. Join a dynamic team dedicated to improving patient outcomes.

Qualifications

• 2-3 years of combined clinical and/or utilization management experience with managed health care plans.
• 3 years of experience in health care revenue cycle or clinic operations.
• Experience in utilization management, including Clinical Appeals and Grievances.

Responsibilities

• Manage clinical denial cases, including analyzing and processing medical necessity denials.
• Draft and submit medical necessity determinations based on clinical documentation reviews.
• Document claims and appeals information in relevant tracking systems and identify denial patterns.

Skills

Clinical Appeals Management

Medical Necessity Determinations

Utilization Management

Education

Registered Nurse (RN) educational background

Tools

Microsoft Office (Excel, Word, Outlook)

Job description

A company is looking for a Registered Nurse - Clinical Appeals & Denials Specialist - Remote.

Key Responsibilities

• Manage clinical denial cases, including analyzing and processing medical necessity denials
• Draft and submit medical necessity determinations based on clinical documentation reviews
• Document claims and appeals information in relevant tracking systems and identify denial patterns

Required Qualifications

• Registered Nurse (RN) educational background
• 2-3 years of combined clinical and/or utilization management experience with managed health care plans
• 3 years of experience in health care revenue cycle or clinic operations
• Experience in utilization management, including Clinical Appeals and Grievances
• Intermediate knowledge of Microsoft Office (Excel, Word, Outlook)