RN Clinical Denials & Appeals Expert

Solution for Health International; Manchester (NH); Sur place; USD 85 000 - 110 000; Plein temps

Avantages offerts par ce poste

Health insurance

Dental insurance

Vision care

Tuition reimbursement

403(b) Retirement savings

Résumé du poste

SolutionHealth is seeking an RN Clinical Appeals Specialist in Manchester, NH to evaluate clinical documentation and support appeals to resolve payer denials. You will coordinate with revenue cycle and clinical teams, review medical records, and craft strong appeal arguments based on policies.

The role requires an RN license with 3+ years in medical coding or billing, familiarity with ICD-10-CM and CPT, and experience with Epic and Excel. A focus on accuracy and process improvements is essential.

Qualifications

• Associate Degree in Nursing and 3+ years in medical coding or billing.
• Current permanent U.S. work authorization; RN license required.
• Knowledge of ICD-10-CM, CPT, DRG methodologies and payer rules.

Responsabilités

• Review clinical denials and initiate appeals per guidelines.
• Perform medical record reviews and draft clinical summaries for appeals.
• Communicate with payer representatives, counsel, and stakeholders.
• Monitor appeals through all stages and ensure timely resolution.
• Draft customized appeal letters aligned with policies and guidelines.
• Apply clinical guidelines to determine status and support arguments.
• Identify root causes of denials and contribute to process improvements.
• Maintain documentation and comply with regulatory requirements.

Connaissances

Medical coding

Auditing

Medical record review

Clinical documentation

Payer denials

Communication

Research & analytics

Time management

Project management

Epic software

Microsoft Excel

Formation

Associate Degree in Nursing

3+ years in medical coding or billing

RN license

Bachelor of Science in Nursing (preferred)

Outils

Epic Coding

HIM software

Revenue Integrity tools

Description du poste

SolutionHealth is seeking an RN Clinical Appeals Specialist in Manchester, NH to evaluate clinical documentation and support appeals to resolve payer denials. You will coordinate with revenue cycle and clinical teams, review medical records, and craft strong appeal arguments based on policies.

The role requires an RN license with 3+ years in medical coding or billing, familiarity with ICD-10-CM and CPT, and experience with Epic and Excel. A focus on accuracy and process improvements is essential.