RN Clinical Denials Strategist

AdventHealth; Florida; On-site; USD 71,000 - 131,000; Full time

Benefits offered by this job

Benefits from Day One: Medical, Dental

PTO from Day One

403-B Retirement Plan

Parental Leave (4 weeks)

Career Development

Whole Person Well-being

Mental Health Resources

Pet Benefits

Job summary

AdventHealth in Florida is seeking a RN to manage clinical denials and perform appeals across service lines. The role emphasizes denial analysis, documentation, and collaboration with revenue cycle teams to optimize reimbursements.

Requirements include an RN license, 2+ years in denials/utilization management, 3+ years RN experience in acute care, and familiarity with CPT/ICD/UB-04 coding. Epic EHR experience preferred.

Qualifications

• Bachelor's of Nursing required.
• 2+ years in clinical denials or utilization management.
• 3+ years as an RN in an acute setting.
• 1+ year in ICU or Med/Surg.
• 1+ year in appeals writing for hospital services.

Responsibilities

• Reviews and appeals clinical denials across service lines system-wide.
• Researches accounts, payer portals, and records to determine appeal strategies.
• Evaluates denial types (charge audit, clinical validation, payer policy).
• Executes charge corrections and rebilling as needed.
• Collaborates with pre-access, financial services, revenue integrity and clinical departments.
• Drafts and submits appeals using clear clinical terminology.

Skills

Charge capture

Revenue integrity

Payer denial understanding

Critical thinking

MS Word/Excel/Outlook

Epic EHR

Team collaboration

Education

Bachelor's of Nursing

Tools

Epic EHR

Microsoft Office

Microsoft Teams

Job description

AdventHealth in Florida is seeking a RN to manage clinical denials and perform appeals across service lines. The role emphasizes denial analysis, documentation, and collaboration with revenue cycle teams to optimize reimbursements.

Requirements include an RN license, 2+ years in denials/utilization management, 3+ years RN experience in acute care, and familiarity with CPT/ICD/UB-04 coding. Epic EHR experience preferred.