Remote RN Denials & Appeals Specialist

Jobgether; Stati Uniti; Remoto; USD 71.000 - 133.000; Tempo pieno

Vantaggi offerti da questo lavoro

Fully remote work

Healthcare coverage from day one

403(b) retirement plan

Paid time off

Descrizione del lavoro

Jobgether represents a partner company seeking a Clinical Denials Management Specialist based in the United States. The role is fully remote and focuses on reviewing, appealing, and preventing denied hospital claims across a healthcare system, working with nursing, utilization management, revenue integrity, and patient financial services teams.

Ideal candidates are experienced RNs with strong clinical judgment and writing skills.

Competenze

• Active RN licensure with three years in an acute clinical setting.
• Experience in denials management or appeals for hospital services.
• Familiarity with CPT/HCPCS, ICD, and UB-04 revenue codes.
• Proficient with utilization review criteria (InterQual/MCG).
• Strong written communication and analytical skills.

Mansioni

• Review and appeal clinical denials with evidence-based strategies.
• Research patient records, payer portals, and billing documentation.
• Prepare persuasive appeal letters reflecting clinical context.
• Defend medical necessity and appropriate level of care.
• Investigate charge-related denials and support rebilling when needed.
• Apply coding and reimbursement standards to support payment.
• Collaborate with cross-functional teams to strengthen submissions.
• Use utilization review criteria in denial defense strategies.
• Identify root causes to prevent future denials and improve docs.
• Provide education and reporting on denial trends and payer requirements.
• Interpret payer policies and contracts to determine requirements.
• Maintain accurate records using clinical and financial systems.
• Manage priorities independently in a high-volume remote environment.
• coordinate via Microsoft Teams for remote collaboration.

Conoscenze

RN licensure

Appeals writing

Denials management

Utilization review

Medical coding knowledge

Formazione

BSN or higher nursing degree

Strumenti

Microsoft Word

Excel

Outlook

Microsoft Teams

Descrizione del lavoro

Jobgether represents a partner company seeking a Clinical Denials Management Specialist based in the United States. The role is fully remote and focuses on reviewing, appealing, and preventing denied hospital claims across a healthcare system, working with nursing, utilization management, revenue integrity, and patient financial services teams.

Ideal candidates are experienced RNs with strong clinical judgment and writing skills.