Remote Nurse Appeals Specialist: Denials & Claims

Knowtion Health; United States; Remote; USD 80,000 - 110,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Life insurance

Short/Long-term disability

Bonus opportunities

401k

Generous PTO

Job summary

Knowtion Health seeks an Appeals Nurse to review medical records and support denials appeals for Medicare, Medicaid, and other payers. You will craft detailed analyses and letters, aligning criteria with payer policies to secure appropriate payments.

The role requires an active RN license and 2+ years in acute care, with 3–5 years in utilization review or related areas. Remote work is supported with a strong benefits package.

Qualifications

• Licensed RN.
• 2 years’ experience in an acute care hospital.
• 3–5 years in utilization review, case management, quality assurance, discharge planning or other cost management programs preferred.
• Experience using InterQual and Milliman healthcare criteria preferred.
• Experience reviewing CMS LCD/NCD criteria preferred.
• Proficient typing and computer skills essential.

Responsibilities

• Review medical record documentation to verify medical necessity issues related to length of stay, level of care, readmissions, and related factors.
• Create detailed clinical analyses and appeal letters for denials to support payment of patient claims.
• Manage inventory and follow up on accounts as appropriate.
• Review InterQual/Milliman and payer policies and include criteria in analysis/letters as appropriate.
• Provide feedback to supervisor regarding issues for training to peers and staff.
• Identify root causes and trending to share with clients and staff.

Skills

Utilization review

Case management

Quality assurance

Discharge planning

Proficient typing

Computer skills

Education

RN license

Tools

InterQual

Milliman

CMS LCD/NCD criteria

Job description

Knowtion Health seeks an Appeals Nurse to review medical records and support denials appeals for Medicare, Medicaid, and other payers. You will craft detailed analyses and letters, aligning criteria with payer policies to secure appropriate payments.

The role requires an active RN license and 2+ years in acute care, with 3–5 years in utilization review or related areas. Remote work is supported with a strong benefits package.