RN Appeals Leader: Denials & Revenue Cycle Strategy

University Medical Center, Inc.; United States; On-site; USD 85,000 - 110,000; Full time

Job summary

UofL Health is seeking a Clinical Denials Management Leader in Louisville, KY to oversee a 10-12 member clinical reviews team and develop strategies to overturn insurance payor denials.

The role collaborates with Revenue Cycle Leadership, Case Management, and Payor Relations to reduce denials and improve pre/post-payment audits, ensuring compliance with regulations across the health system.

Qualifications

• Bachelor’s degree in nursing is required.
• 5+ years of clinical experience is required.
• Experience with appeals and/or denial processing is preferred.
• Clinical nursing experience in a hospital setting (ER/CCU/Diagnostics) preferred.
• CCM/CPUM or similar certification are preferred.
• Active, unrestricted registered nurse license required.

Responsibilities

• Oversee appeals team to ensure timely denial resolution and staff performance.
• Track, trend, and reduce denials based on root causes with monthly reporting.
• Collaborate with Care Management and HIM Coding on feedback for denials.
• Ensure Audit Recovery claims from Medicare/Medicaid are processed and appeals submitted timely.
• Research payer policies and regulations to appeal denied claims and prevent future denials.
• Communicate denial trends to providers and internal stakeholders.

Skills

Nursing leadership

Denials management

Clinical auditing

Policy development

Education

BSN

Tools

MS Excel

Word

Outlook

Job description

UofL Health is seeking a Clinical Denials Management Leader in Louisville, KY to oversee a 10-12 member clinical reviews team and develop strategies to overturn insurance payor denials.

The role collaborates with Revenue Cycle Leadership, Case Management, and Payor Relations to reduce denials and improve pre/post-payment audits, ensuring compliance with regulations across the health system.