Remote Clinical Denials & Appeals Specialist II

Franciscan Alliance, Inc.; Oregon; Hybrid; USD 67,000 - 92,000; Full time

Job summary

Franciscan Alliance, Inc. is seeking a Clinical Denial Specialist II to support hospital denial appeals and data-driven improvements. The role requires retrospective review of patient records via EPIC and coordination with clinical teams to address denials.

The position is remote in the United States with standard weekday hours. Qualifications include nursing degrees, an Indiana RN license, denial-related experience, and preferred case management experience.

Qualifications

• Bachelor's degree in Nursing or Associate degree in Nursing with 5 years of nursing experience required.
• Active Indiana RN license required.
• 3 years of denial related experience required.
• 5 years Nursing or Case Management preferred.

Responsibilities

• Develop reports.
• Review governmental contractor's response.
• Identify root causes for potential denials and work with departments and Clinical Documentation Integrity to reduce denials.
• Write and ensure all appeals are filed promptly for Medicare, Medicaid, Managed, and Commercial payors.
• Audit medical documentation for adherence to insurance and CMS guidelines.
• Use inpatient criteria to establish medical necessity letters.

Skills

Nursing experience

Education

Bachelor's degree in Nursing

Associate degree in Nursing

Tools

EPIC

Job description

Franciscan Alliance, Inc. is seeking a Clinical Denial Specialist II to support hospital denial appeals and data-driven improvements. The role requires retrospective review of patient records via EPIC and coordination with clinical teams to address denials.

The position is remote in the United States with standard weekday hours. Qualifications include nursing degrees, an Indiana RN license, denial-related experience, and preferred case management experience.