RN Clinical Appeals Pro — Denials & Revenue Integrity

Elliot Health System; New Hampshire; Sur place; USD 70 000 - 95 000; Plein temps

Avantages offerts par ce poste

Health, dental, vision insurance

Tuition reimbursement

Nursing Student Loan Paydown

403(b) Retirement savings plans

Continuous earned time accrual

Résumé du poste

The Elliot Health System in New Hampshire is seeking a Nurse Appeals Specialist to evaluate clinical documentation and support appeal decisions related to payer denials. You will review medical records, prepare summaries, and draft compelling appeal letters in coordination with the Revenue Cycle team and clinical staff.

Ideal candidates hold an RN license with 3+ years in medical coding or billing, familiarity with Epic, and strong analytical and communication skills to improve denial outcomes

Qualifications

• Associate degree in Nursing plus 3+ years in medical coding or billing.
• RN license required; BSN preferred.
• Knowledge of ICD-10-CM, CPT, DRG methodologies and payer rules.

Responsabilités

• Review clinical denials and initiate appeals per guidelines.
• Prepare clinical summaries to support appeals and align with payer policies.
• Draft customized appeal letters using clinical documentation and guidelines.
• Coordinate with payer reps, counsel, and internal teams throughout the appeal process.
• Monitor and escalate as needed to ensure timely resolutions.

Connaissances

Auditing and coding

Medical record review

Clinical documentation

Communication

Time management

Regulatory compliance

Formation

Associate Nursing Degree

BSN preferred

RN license

Outils

Epic

Microsoft Excel

Coding software

Description du poste

The Elliot Health System in New Hampshire is seeking a Nurse Appeals Specialist to evaluate clinical documentation and support appeal decisions related to payer denials. You will review medical records, prepare summaries, and draft compelling appeal letters in coordination with the Revenue Cycle team and clinical staff.

Ideal candidates hold an RN license with 3+ years in medical coding or billing, familiarity with Epic, and strong analytical and communication skills to improve denial outcomes