LPN - Clinical Denials Specialist
About The Position
MU Health Care is looking for a detail-oriented LPN - Clinical Denials Specialist who is passionate about improving processes, solving complex challenges, and protecting the financial health of our organization. The ideal candidate is a proactive problem-solver with strong communication skills who enjoys collaborating with clinical teams, physicians, and revenue cycle leaders to identify and resolve claim denial issues. In this impactful role, you will investigate payer denials, manage authorization-related challenges, analyze trends, and uncover opportunities to enhance reimbursement outcomes. We value professionals who can think critically, identify root causes, and drive meaningful improvements that reduce denials and support operational excellence. Join MU Health Care and play a key role in advancing efficient, patient-centered care while helping ensure the resources needed to serve our communities remain strong.
Requirements
- Missouri Board of Nursing LPN or Nurse Licensure Compact multi-state LPN. When primary state of residency changes, compact state LPNs must apply under new state of residency within thirty (30) days.
- Two (2) years of relevant experience in utilization review, denials management, prior-authorization, medical auditing, or similar healthcare experience.
- Ability to evaluate and investigate issues to determine effective resolution to avoid negative financial impact.
- Excellent interpersonal, written, and verbal skills.
- Ability to communicate effectively with a variety of individuals including physicians and clinical team members.
- Proficient in Microsoft Office (including Excel and PowerPoint) and in personal computer use.
Nice To Haves
- Experience with medical and insurance terminology, CPT, ICD-10 coding structures, and billing forms.
- Experience with payer guidelines and CMS Utilization Management and billing requirements.
- Experience with working with data to analyze, trend, and present findings.
- Additional license/certification requirements as determined by the hiring department.
Responsibilities
- Research payer denials related to referral, authorization, notifications, and medical necessity resulting in denials and delays in payment.
- Submit retro-authorizations in accordance with payer requirements in response to authorization denials.
- Identify denial patterns and escalate to management as appropriate with sufficient information for additional follow-up and/or root-cause avoidance and resolution.
- Make recommendations for additions/revisions/deletions to work queues and claim edits to improve efficiency and reduce denials.
- Review payer communications, identifying risk for loss reimbursement related to medical policies and authorization requirements; escalate potential issues to clinical stakeholders, managed care contracting, and Revenue Cycle leadership as appropriate.
- Identify opportunities for process improvement and actively participate in process improvement initiatives.
- May complete unit/department specific duties as outlined in department documents.
Benefits
- Health, vision and dental insurance coverage starting day one
- Generous paid leave and paid time off, including ten holidays
- Multiple retirement options, including 100% matching up to 8% and full vesting in three years
- Tuition assistance for employees (75%) and immediate family members (50%)
- Discounts on cell phone plans, rental cars, gyms, hotels and more
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What This Job Offers
Job Type
Part-time
Career Level
Mid Level
Education Level
No Education Listed
