RN Denial Mitigation & Appeals Specialist II

Baptist Memorial Health Care Corporation; Memphis (TN); Hybrid; USD 65,000 - 90,000; Full time

Job summary

Baptist Memorial Health Care Corporation is seeking an experienced Denial Mitigation-Appeal Specialist II RN to support revenue cycle by reviewing clinical cases, preparing appeals, and coordinating with payers to defend denied claims.

The role involves collaborating with physicians, coding/billing teams, and hospital departments to optimize reimbursement and ensure timely appeal submissions. Remote work may be possible after probation upon meeting productivity goals.

Qualifications

• RN with 5 years clinical experience in acute healthcare setting and 3–5 years insurance provider, auditing, or medical review experience related to denied claims.
• Graduate of an accredited nursing program.
• Familiarity with electronic medical records and claims/practice management systems.
• Ability to use payer criteria and perform clinical/financial reviews.

Responsibilities

• Reviews and analyzes communications to optimize reimbursement.
• Compiles appeals with clinical and financial information for payer responses.
• Communicates with physician practices to obtain documentation for appeals.
• Collaborates with coding/billing for denial resolution and escalation as needed.
• Assists in preparing timelines and summaries for denial management.

Skills

Interpersonal skills

Written communication

Computer literacy

Analytical thinking

Problem solving

Education

Graduate of an accredited nursing program

Tools

EMR systems

Claims management systems

Job description

Baptist Memorial Health Care Corporation is seeking an experienced Denial Mitigation-Appeal Specialist II RN to support revenue cycle by reviewing clinical cases, preparing appeals, and coordinating with payers to defend denied claims.

The role involves collaborating with physicians, coding/billing teams, and hospital departments to optimize reimbursement and ensure timely appeal submissions. Remote work may be possible after probation upon meeting productivity goals.