Clinical Appeals RN-FT-Variable Hours

Centra Medical Group

10d

About The Position

The Clinical Appeals RN is responsible for the identification and resolution of technical and/or clinical based denials through appeals. The Appeals Nurse will work with Revenue Cycle staff, case management, clinical departments, practices, and insurance payers (government & commercial) to identify the source of denials and develop processes to eliminate and/or minimize denials and rejections to improve cash flow. The Appeals Nurse works denied and underpaid accounts to obtain full reimbursement for services provided and identify the underlying root cause. The Appeals Nurse will develop recommendations and education plans to prevent future denials and will routinely communicate findings and activities to stakeholders. An Appeals Nurse will serve as the central point person for recovery and audit activities as they relate to clinical denials and overpayments. The Appeals Nurse will be responsible for ensuring clinical appeal deadlines are met to maintain maximum opportunity for reimbursement retention.

Requirements

• Registered Nurse (RN) license
• Experience in clinical appeals
• Knowledge of revenue cycle processes
• Familiarity with case management
• Understanding of clinical departments and practices
• Experience working with government and commercial insurance payers
• Ability to identify root causes of denials
• Strong communication skills for stakeholder updates
• Ability to manage deadlines

Responsibilities

• Identification and resolution of technical and/or clinical based denials through appeals.
• Work with Revenue Cycle staff, case management, clinical departments, practices, and insurance payers to identify the source of denials.
• Develop processes to eliminate and/or minimize denials and rejections to improve cash flow.
• Work denied and underpaid accounts to obtain full reimbursement for services provided.
• Identify the underlying root cause of denials.
• Develop recommendations and education plans to prevent future denials.
• Routinely communicate findings and activities to stakeholders.
• Serve as the central point person for recovery and audit activities as they relate to clinical denials and overpayments.
• Ensure clinical appeal deadlines are met to maintain maximum opportunity for reimbursement retention.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 1,001-5,000 employees