RN Denial Mitigation & Appeal Specialist II

Baptist; Oregon; Hybrid; USD 85,000 - 110,000; Full time

Job summary

Baptist is seeking an experienced Denial Mitigation-Appeal Specialist II RN to lead denial reviews and appeals for inpatient and other services. You will analyze clinical records, craft appeals, and coordinate with payers, physicians, and billing teams to maximize reimbursement.

The role requires strong communication and analytical skills, familiarity with payer guidelines, and the ability to work with EMR and practice management systems. Potential remote work after 90 days.

Qualifications

• RN with 5 years clinical experience in an acute care setting and 3–5 years in denial-related roles.
• Graduate of an accredited nursing program; nursing licensure required.
• Familiarity with electronic medical records and claims/practice management systems.

Responsibilities

• Prioritize, organize, and communicate clearly to support timely appeals.
• Review clinical records and payer guidelines to prepare robust appeals.
• Collaborate with physicians, coding, and billing to optimize denials resolution.
• Submit retro-authorization requests, reconsiderations, and appeals within timelines.
• Monitor denial trends and escalate to management as needed.
• Engage in remote work after achieving productivity and training goals.

Skills

RN

Denial management

Case management

Auditing

Communication

Education

Nursing degree

Tools

EMR systems

Claims management systems

Job description

Baptist is seeking an experienced Denial Mitigation-Appeal Specialist II RN to lead denial reviews and appeals for inpatient and other services. You will analyze clinical records, craft appeals, and coordinate with payers, physicians, and billing teams to maximize reimbursement.

The role requires strong communication and analytical skills, familiarity with payer guidelines, and the ability to work with EMR and practice management systems. Potential remote work after 90 days.