RN Clinical Appeals

Ensemble Health Partners; United States; On-site; USD 56,000 - 109,000; Full time

Job summary

A leading healthcare solutions provider in the United States is seeking an RN Clinical Appeals specialist to focus on reviewing claim denials and reducing future denials through root-cause analysis. Responsibilities include contacting insurance plans, preparing appeals, and collaborating with various departments. Candidates must hold a current RN license and have relevant experience. A competitive salary and comprehensive benefits are offered.

Benefits

Competitive salary

Bonus incentives

Paid certifications

Tuition reimbursement

Comprehensive benefits package

Career advancement opportunities

Qualifications

• CRCR or other approved professional certification required within 9 months of hire.
• 1 to 3 years of experience in denials, utilization review, or case management preferred.
• Experience in hospital operations and provider relations preferred.

Responsibilities

• Contact insurance plans to determine reasons for claim denials.
• Prepare appeal materials, correct and resubmit claims.
• Act as a liaison between healthcare providers and payers.

Skills

Current unrestricted RN license

Proficient computer skills

Education

Associate’s Degree or equivalent experience

Tools

Microsoft Suite

Job description

RN Clinical Appeals

Ensemble Health Partners is a leading provider of technology‑enabled revenue cycle management solutions for health systems. The RN Clinical Appeals role focuses on reviewing claim denials and performing root‑cause analysis to reduce future denials.

Responsibilities

• Contact insurance plans to determine reasons for claim denials and assess whether an appeal is necessary.
• Prepare appeal materials, correct and resubmit claims, and gather additional information from medical records.
• Act as a liaison between healthcare providers and payers to obtain required documentation or clarifications.
• Submit appeals in a timely manner, ensuring compliance with regulatory requirements.
• Collaborate with Case Management, HIM, Physician Advisory, Clinical Denials, Denial Prevention, Accounts Receivable, and Virtual Utilization Review to communicate denial trends and outcomes.

Qualifications

• Current unrestricted RN license.
• CRCR or other approved professional certification required with 9 months of date of hire.
• 1 to 3 years of experience in denials, utilization review, or case management preferred.
• Associate’s Degree or equivalent experience required.
• Proficient computer skills, including Microsoft Suite.
• Experience in hospital operations, chart audit/review, and provider relations preferred.

Benefits

• Competitive salary range: $56,800 – $108,900 based on experience.
• Bonus incentives.
• Paid certifications and tuition reimbursement.
• Comprehensive benefits package.
• Career advancement opportunities.

EEO Statement

Ensemble Health Partners is an equal employment opportunity employer. It is our policy not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender, gender identity, religion, national origin, age, disability, military or veteran status, genetic information or any other basis protected by applicable federal, state, or local laws. Ensemble Health Partners also prohibits harassment of applicants or employees based on any of these protected categories.

Ensemble Health Partners provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law. If you require accommodation in the application process, please contact [e-mail].