RN Clinical Appeals Specialist - Part Time

University of Mississippi Medical Center; Jackson (MS); On-site; USD 28,000 - 55,000; Part time

Job summary

University of Mississippi Medical Center is seeking a part-time Clinical Appeals Coordinator to support the Rev Cycle - Patient Access PAU team. The role coordinates the billing process, reviews denials, and manages appeals with insurers while collaborating with clinical and administrative staff to minimize financial risk.

Two years of nursing experience and a valid RN license are required; utilization review and case management experience are preferred.

Qualifications

• Two (2) years of nursing experience.
• Valid RN license.
• Utilization review and case management experience.

Responsibilities

• Reviews patient medical records and collects data to support billing and appeals management, analysis, and monitoring activities.
• Communicates with insurers to determine the appropriateness of payments or denials.
• Collects, reviews, and submits timely appeals for medical necessity and authorization of denials.
• Conducts clinical research and analysis to identify issues and develop strategies that improve the payment and appeals process.
• Assists with chart audits by reviewing and comparing medical records against itemized patient bills to ensure accuracy and maintain revenue integrity.
• Analyzes denial and payment data to identify trends and patterns, supporting system-wide performance improvement and management education.
• Supports quality improvement initiatives by reviewing clinical practices for consistency, adherence to policy, and appropriate levels of care across settings; prepares reports and communicates findings to clinical and non‑clinical staff.
• Communicates and negotiates with external stakeholders, including insurance payers, regarding appeal outcomes.
• Maintains knowledge of current regulatory and accreditation standards related to denial and appeals management to support organizational compliance.

Skills

Clinical workflow

Multitasking

Verbal/written communication

Analytical skills

Problem solving

Education

RN license

Job description

University of Mississippi Medical Center is seeking a part-time Clinical Appeals Coordinator to support the Rev Cycle - Patient Access PAU team. The role coordinates the billing process, reviews denials, and manages appeals with insurers while collaborating with clinical and administrative staff to minimize financial risk.

Two years of nursing experience and a valid RN license are required; utilization review and case management experience are preferred.