RN Appeals Specialist: Drive Denial Resolutions

Elliot Health System; Manchester (NH); On-site; USD 75,000 - 110,000; Full time

Benefits offered by this job

Health insurance

Tuition reimbursement

Nursing student loan payoff program

401(k) retirement plan

Job summary

Elliot Health System is seeking a Nurse Appeals Specialist to perform comprehensive reviews of clinical documentation, support payer denials appeals, and collaborate with clinical and revenue cycle teams to improve revenue integrity. The role requires RN licensure and coding experience, with exposure to Epic and related systems.

The position is on-site in Manchester, NH, with opportunities for professional growth.

Qualifications

• RN licensure in the U.S. required.
• CPC/CPC-H/CCS/CCS-P/RHIT/RHIA certifications preferred.
• 3–5+ years in auditing and coding experience.
• Experience with medical chart review and coding/billing.
• Knowledge of ICD-10-CM, CPT, DRG methodologies and payer rules.
• Proficient with Microsoft Office and relevant coding/billing software.

Responsibilities

• Review denials and initiate appeals per internal and payer guidelines.
• Perform thorough medical record reviews and prepare clinical summaries for appeals.
• Communicate with payer reps, counsel, and stakeholders throughout appeals.
• Monitor appeals through all stages and escalate as needed.
• Assist billing and case management on high-risk accounts before submission.
• Analyze denial data to identify patterns and inform process improvements.
• Draft customized appeal letters grounded in clinical documentation and guidelines.
• Maintain timely documentation of all appeal activities while coordinating resources.
• Stay current with policy changes and best practices in denial management.
• Adhere to confidentiality and regulatory requirements.

Skills

Critical thinking

Data analysis

Communication skills

Time management

Growth mindset

Education

Associate Degree in Nursing

BSN preferred

Tools

Epic Coding

Microsoft Excel

HIM software

Revenue Integrity tools

Job description

Elliot Health System is seeking a Nurse Appeals Specialist to perform comprehensive reviews of clinical documentation, support payer denials appeals, and collaborate with clinical and revenue cycle teams to improve revenue integrity. The role requires RN licensure and coding experience, with exposure to Epic and related systems.

The position is on-site in Manchester, NH, with opportunities for professional growth.