Remote Denials & Appeals Specialist (RN)

Nahsedfw; Dallas (TX); Hybrid; USD 85,000 - 110,000; Full time

Benefits offered by this job

Health coverage

Retirement plan match

Paid parental leave

Caregiver leave

Adoption and surrogacy reimbursement

Job summary

Children's Health in Dallas seeks a Denials Management Specialist to lead denial resolution efforts across medical, authorization and reimbursement domains. The role requires collaboration with Utilization Management and other teams, with a hybrid schedule (remote with onsite 2x/month) in a pediatric health system rooted in Dallas.

The ideal candidate has RN licensure, at least 3 years in denial/authorization management, and is skilled in payer policy navigation and appeal strategies.

Qualifications

• Minimum 3 years in authorization, UM, CM, or denial management.
• Minimum 5 years of clinical nursing experience preferred.
• RN licensed with active credentialing.

Responsibilities

• Independently manage peer-to-peer reviews, expedited appeals, standard appeals and retrospective reviews.
• Apply clinical judgment to evaluate medical necessity, authorization criteria and supporting documentation.
• Maintain knowledge of payer policies, authorization requirements, appeal rights and reimbursement rules.
• Monitor and analyze denial trends by payer, diagnosis and service type to identify root causes.
• Partner with revenue, managed care, patient access, pharmacy and clinical teams to resolve denials.
• Serve as a subject matter expert and educate team members on denial and appeal workflows.

Skills

Authorization/denial management

Clinical nursing experience

Education

Bachelor's degree or equivalent experience

RN license

Job description

Children's Health in Dallas seeks a Denials Management Specialist to lead denial resolution efforts across medical, authorization and reimbursement domains. The role requires collaboration with Utilization Management and other teams, with a hybrid schedule (remote with onsite 2x/month) in a pediatric health system rooted in Dallas.

The ideal candidate has RN licensure, at least 3 years in denial/authorization management, and is skilled in payer policy navigation and appeal strategies.