Remote Clinical Appeals RN: Boost Reimbursement Outcomes

Health Business Solutions; United States; À distance; USD 70 000 - 100 000; Plein temps

Résumé du poste

Health Business Solutions LLC is seeking a Clinical Appeals Nurse (RN) for a remote role. The position focuses on reviewing denied claims for clinical accuracy and medical necessity, developing appeal strategies, and drafting payer-ready documentation to overturn denials and improve reimbursement outcomes.

The role requires an active US RN license and 3–5 years of clinical nursing experience, with preferred BSN.

Qualifications

• Active Registered Nurse license in the United States.
• 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 skills for persuasive appeal narratives.

Responsabilités

• Review medical records and denial rationale to identify appeal opportunities.
• Assess medical necessity using guidelines, payer policies, and regulatory standards.
• 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.
• Track appeal outcomes and contribute to reports on overturn rates and trends.
• Maintain HIPAA compliance and client confidentiality.
• Participate in process improvement initiatives to boost success and efficiency.

Connaissances

RN license (US)

3–5 years clinical nursing

Medical necessity criteria

Medical records review

Written communication

Formation

BSN (preferred)

Description du poste

Health Business Solutions LLC is seeking a Clinical Appeals Nurse (RN) for a remote role. The position focuses on reviewing denied claims for clinical accuracy and medical necessity, developing appeal strategies, and drafting payer-ready documentation to overturn denials and improve reimbursement outcomes.

The role requires an active US RN license and 3–5 years of clinical nursing experience, with preferred BSN.