Remote Clinical Appeals Nurse (RN) - Denials & Revenue

Health Business Solutions; United States; Remote; USD 90,000 - 120,000; Full time

Job summary

HBiz seeks a Clinical Appeals Nurse (RN) to remotely support revenue cycle operations. You will review denied claims for clinical accuracy, develop evidence-based appeal strategies, and draft payer-ready documentation to overturn denials and improve reimbursement.

The role requires strong clinical reasoning, experience in medical necessity criteria, and collaboration across coding, CDI, and denial recovery teams to drive compliant, timely appeals.

Qualifications

• Active RN license in the United States.
• Minimum 3–5 years of clinical nursing experience.
• Strong understanding of medical necessity criteria and payer review processes.
• Experience reviewing medical records and clinical documentation.
• Excellent written communication for persuasive appeal narratives.

Responsibilities

• Review medical records and denial rationale to identify appeal opportunities.
• Assess medical necessity using clinical guidelines and payer policies.
• Draft payer-ready appeal letters for multiple levels of appeal.
• Collaborate with coding, CDI, denial recovery, and operations teams to strengthen strategy.
• Identify documentation gaps and recommend improvements to reduce denials.
• Support peer-to-peer review preparation and provide clinical insight.

Skills

RN license

Clinical nursing

Medical necessity understanding

Appeal writing

Documentation review

Education

Active RN license in the United States

BSN (preferred)

Job description

HBiz seeks a Clinical Appeals Nurse (RN) to remotely support revenue cycle operations. You will review denied claims for clinical accuracy, develop evidence-based appeal strategies, and draft payer-ready documentation to overturn denials and improve reimbursement.

The role requires strong clinical reasoning, experience in medical necessity criteria, and collaboration across coding, CDI, and denial recovery teams to drive compliant, timely appeals.