Remote Clinical Appeals Nurse - Denials & Compliance

Atrium Health; Charlotte (NC); Remote; USD 53,000 - 79,000; Full time

Benefits offered by this job

Health benefits

Paid time off

Retirement plan

Educational assistance

Job summary

Atrium Health is seeking a Clinical Appeal Nurse to join our fully remote Revenue Recovery Audit team. This RN role focuses on evaluating denied claims, applying level-of-care criteria, and preparing clinical appeals with medical necessity documentation.

Must hold an NC compact license and apply for an IL license after 90-day probation if external hire. You will collaborate with utilization management, coding, and payer partners to overturn denials and support denial prevention initiatives.

Qualifications

• Bachelor’s degree in nursing required; three years clinical experience in acute care preferred, with denials/appeals/government audits experience.
• Ability to meet deadlines in a fast-paced environment and work independently.
• Experience with level of care criteria (MCG/InterQual), Medicare guidelines, and reimbursement methodologies.

Responsibilities

• Utilize nursing expertise to assess denied claims for timely evaluation and determine eligibility for appeal.
• Know CMS regulations and payer-specific audit protocols; apply policy standards in medical record reviews.
• Research denied claims to determine eligibility and prepare clinical appeals with necessary documentation.
• Use AI tools to enhance appeal writing efficiency while maintaining accuracy.
• Escalate denial issues and coordinate withRevenue Cycle teams to improve denial prevention strategies.

Skills

RN clinical expertise

CMS regulations knowledge

Denial management

Epic proficiency

Strong writing skills

Analytical thinking

Education

Bachelor’s Degree in Nursing or ASN with BSN

Tools

Epic

Denial management software

Job description

Atrium Health is seeking a Clinical Appeal Nurse to join our fully remote Revenue Recovery Audit team. This RN role focuses on evaluating denied claims, applying level-of-care criteria, and preparing clinical appeals with medical necessity documentation.

Must hold an NC compact license and apply for an IL license after 90-day probation if external hire. You will collaborate with utilization management, coding, and payer partners to overturn denials and support denial prevention initiatives.