RN Clinical Appeals Specialist — Denials & Revenue Cycle

SolutionHealth; Manchester (NH); Sur place; USD 75 000 - 105 000; Plein temps

Avantages offerts par ce poste

Health insurance

Dental insurance

Vision coverage

Prescription coverage

Tuition reimbursement

Nursing student loan payoff

403(b) Retirement plan

Paid time off

Résumé du poste

SolutionHealth in Manchester, NH seeks a Nurse Appeals Specialist to evaluate clinical documentation and support the denial appeals process. You will work with clinical and revenue cycle teams to reduce denials and improve revenue integrity.

The role involves reviewing denials, drafting compelling appeal letters, and presenting to payers under policy guidelines. A strong nursing background with coding/auditing experience is required.

Qualifications

• Associate degree in nursing with 3+ years in medical coding or billing.
• Current U.S. work authorization and RN license.
• CPC/CPC-H/CCS/CCS-P/RHIT/RHIA certification preferred.
• Strong knowledge of ICD-10-CM, CPT, DRG and payer rules.
• Experience with medical chart review and audits.

Responsabilités

• Review clinical denials and initiate the appeals process per guidelines.
• Perform thorough medical record reviews and draft appeal summaries.
• Communicate with payers, legal, and stakeholders through appeals.
• Monitor appeals and escalate when needed to achieve timely resolutions.
• Assist billing and case management in high-risk accounts before submission.
• Analyze denial data to identify root causes and suggest improvements.

Connaissances

Attention to detail

Analytical skills

Verbal and written communication

Growth mindset

Formation

Associate Degree in Nursing

RN license

BSN preferred

Certified coder (CPC/CPC-H/CCS/CCS-P/RHIT/RHIA)

Outils

Epic

HIM software

Excel

Appeals software

Description du poste

SolutionHealth in Manchester, NH seeks a Nurse Appeals Specialist to evaluate clinical documentation and support the denial appeals process. You will work with clinical and revenue cycle teams to reduce denials and improve revenue integrity.

The role involves reviewing denials, drafting compelling appeal letters, and presenting to payers under policy guidelines. A strong nursing background with coding/auditing experience is required.