RN Appeals & Denials Specialist - Clinical Insight

20 Elliot Hospital of the City of Manchester; Manchester (NH); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Health, dental, prescription, and vis­

Disability and life insurance

Job summary

SolutionHealth is seeking a Nurse Appeals Specialist to evaluate clinical documentation, support denial appeals, and collaborate with clinical and revenue cycle teams to reduce denials and improve revenue integrity. The role involves thorough chart reviews, crafting persuasive appeal letters, and applying InterQual/Milliman guidelines to determine status determinations.

They will engage with payers, legal counsel, and internal teams, ensuring timely submissions and adherence to regulatory

Qualifications

• Associate Degree in Nursing and 3+ years in medical coding or billing.
• Current permanent U.S. work authorization required.
• Bachelor of Science in Nursing preferred.

Responsibilities

• Review clinical denials and initiate appeals process per guidelines.
• Prepare clinical summaries to support appeals, aligned with payer policies.
• Communicate with payer representatives, counsel, and stakeholders throughout the appeal process.
• Present appeals to Administrative Law Judges when appropriate.
• Monitor appeal progress and escalate when needed to ensure timely resolutions.

Skills

Attention to detail

Analytical skills

Communication skills

Time management

Project management

Education

Associate Degree in Nursing

Bachelor of Science in Nursing

Tools

Epic Coding

HIM

Revenue Integrity software

Job description

SolutionHealth is seeking a Nurse Appeals Specialist to evaluate clinical documentation, support denial appeals, and collaborate with clinical and revenue cycle teams to reduce denials and improve revenue integrity. The role involves thorough chart reviews, crafting persuasive appeal letters, and applying InterQual/Milliman guidelines to determine status determinations.

They will engage with payers, legal counsel, and internal teams, ensuring timely submissions and adherence to regulatory