Senior Clinical Denials & Appeals Specialist

AdventHealth; Florida; Presencial; USD 71.000 - 133.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical, Dental, Vision Insurance

Paid Time Off from Day One

403-B Retirement Plan

4 Weeks 100% Paid Parental Leave

Career Development

Whole Person Well-being Resources

Mental Health Resources and Support

Pet Benefits

Descripción de la vacante

AdventHealth in Florida is seeking an experienced Registered Nurse to review and appeal denials for clinical services across the system. You will research payer policies, charge histories, and determine appropriate actions, collaborating with pre-access, patient financial services, revenue integrity, and clinical departments.

The role requires RN licensure, strong documentation skills, and expertise in CPT/ICD/HCPCS coding, utilization review, and appeal strategy.

Formación

• Extensive understanding of CPT, HCPCS, ICD, UB-04 and payer policies.
• Ability to defend clinical validation of diagnoses and appeals.
• Experience with utilization review and determination of inpatient vs observation.

Responsabilidades

• Review and appeal denials for clinical services across the system.
• Research payer policies and charge histories to support appeals.
• Collaborate with patient financial services and clinical staff to obtain necessary information for appeals.

Conocimientos

CPT/HCPCS/ICD knowledge

Regulatory and payer rules

MS Word/Excel/Outlook

MS Teams proficiency

EMR navigation

Educación

Bachelor's degree

Master's degree

Herramientas

InterQual/MCG references

Descripción del empleo

AdventHealth in Florida is seeking an experienced Registered Nurse to review and appeal denials for clinical services across the system. You will research payer policies, charge histories, and determine appropriate actions, collaborating with pre-access, patient financial services, revenue integrity, and clinical departments.

The role requires RN licensure, strong documentation skills, and expertise in CPT/ICD/HCPCS coding, utilization review, and appeal strategy.