Remote Clinical Appeals Nurse

Hugh Chatham Health, Inc.; Charlotte (NC); À distance; USD 53 000 - 79 000; Plein temps

Avantages offerts par ce poste

Paid Time Off

Health benefits

Dental & vision coverage

Retirement plan with employer match

Educational assistance

Résumé du poste

Advocate Health is hiring a Clinical Appeals RN for a fully remote role. You will assess denied claims using nursing expertise, determine eligibility for appeals, and ensure compliance with CMS and payer requirements.

Strong writing and collaboration are essential as you prepare and coordinate appeals with revenue cycle teams. Required are a nursing degree and an unrestricted RN license, with 3+ years acute care experience; licensure in NC and IL licensing after probation may be needed.

Qualifications

• Bachelor’s Degree in Nursing or ADN with BSN.
• Minimum 3 years clinical experience in acute care; utilization review, case management, or denials/appeals experience preferred.

Responsabilités

• Assess denied claims using clinical criteria and determine eligibility for appeals.
• Apply CMS regulations and payer-specific requirements to appeals.
• Review medical records, document medical necessity, and prepare appeals.
• Research denied claims against payer and government rules for eligibility.
• Leverage AI tools to improve appeal writing accuracy and efficiency.
• Continue appeals until overturned or options exhausted with thorough documentation.
• Coordinate with departments to address denial patterns and improve processes.
• Escalate issues to leadership and participate in payer meetings as needed.

Connaissances

Critical thinking

Analytical skills

Deadline-driven

Excellent writing

Communication

Team collaboration

Microsoft Office

Epic experience

Denial management software

Formation

Bachelor’s or ADN with BSN

Outils

Microsoft Office

Epic

Denial management software

Description du poste

Advocate Health is hiring a Clinical Appeals RN for a fully remote role. You will assess denied claims using nursing expertise, determine eligibility for appeals, and ensure compliance with CMS and payer requirements.

Strong writing and collaboration are essential as you prepare and coordinate appeals with revenue cycle teams. Required are a nursing degree and an unrestricted RN license, with 3+ years acute care experience; licensure in NC and IL licensing after probation may be needed.