RN Clinical Appeals Specialist: Denials & Revenue Integrity Lead

Elliotphysicians; Manchester (NH); On-site; USD 70,000 - 95,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Life insurance

Tuition reimbursement

Nursing student loan payoff

Retirement plan

Paid time off

Job summary

Elliot Health System is seeking an RN Clinical Appeals Specialist in Manchester, NH. You will evaluate clinical documentation to support payer denials, craft compelling appeal letters, and collaborate with revenue cycle teams to reduce denials and improve revenue integrity.

The role requires an RN license, 3+ years in medical coding or billing, and knowledge of ICD-10-CM, CPT, and DRG methodologies. Familiarity with Epic and related systems is a plus.

Qualifications

• RN license and current U.S. work authorization
• 3+ years in medical coding or billing
• Experience with auditing and chart review
• Knowledge of ICD-10-CM, CPT, DRG methodologies
• Familiarity with Epic, HIM and coding/billing systems

Responsibilities

• Review clinical denials and initiate appeals process following guidelines.
• Conduct medical record reviews and prepare summaries to support appeals.
• Communicate with payer representatives, counsel, and stakeholders throughout the appeal.
• Monitor appeals through all stages and escalate as needed.
• Draft customized appeal letters aligned with payer policies.
• Apply InterQual/Milliman guidelines to support arguments.
• Assess reimbursement risk and escalate complex issues.
• Ensure timely documentation and record-keeping.

Skills

Nursing

Attention to detail

Verbal communication

Analytical thinking

Time management

Education

Associate Degree in Nursing

BSN preferred

Tools

Epic Coding

HIM

Revenue Integrity software

Microsoft Excel

Job description

Elliot Health System is seeking an RN Clinical Appeals Specialist in Manchester, NH. You will evaluate clinical documentation to support payer denials, craft compelling appeal letters, and collaborate with revenue cycle teams to reduce denials and improve revenue integrity.

The role requires an RN license, 3+ years in medical coding or billing, and knowledge of ICD-10-CM, CPT, and DRG methodologies. Familiarity with Epic and related systems is a plus.