RN Clinical Denial Recovery Analyst | Enterprise Denials

UF Health•Jacksonville, FL

5d•Remote

About The Position

Work remotely with a collaborative enterprise denials team focused on reimbursement accuracy and revenue recovery. The Clinical Denial Management Nurse is responsible for completing, tracking, and reporting clinical denials across all UF hospitals at an enterprise level. Reporting to the Enterprise Denial Nurse Manager, this role supports key revenue cycle functions including clinical departments, finance, accounting, compliance, patient financial services, revenue integrity, managed care, utilization review, and patient access. Serves as a clinical expert in denial management, reviewing denied claims from a clinical perspective and developing effective appeal strategies. Ensures appropriate documentation and submission of appeals to maximize reimbursement and minimize organizational write-offs. Collaborates with cross-functional teams to identify denial trends, improve processes, and support enterprise-wide initiatives that enhance revenue cycle performance and compliance.

Requirements

Licensed to practice nursing as a Registered Nurse (RN) or Licensed Practical Nurse (LPN) in the state of Florida required
2–3 years of clinical experience as a RN required OR 3–5 years of clinical experience as a LPN required

Nice To Haves

Bachelor’s Degree in Nursing (BSN) preferred
Knowledge or experience related to, medical record review, auditing, or insurance processes preferred

Responsibilities

Review, track, and manage clinical denials and appeals to support reimbursement optimization and minimize organizational write-offs
Analyze denied claims from a clinical perspective and prepare accurate, well-supported appeals
Collaborate with revenue cycle, finance, compliance, managed care, utilization review, patient access, and clinical departments to resolve denial issues
Research payer policies, contracts, EOBs, and reimbursement guidelines to support claim resolution activities
Monitor denial trends and identify opportunities for process improvement and denial prevention
Maintain compliance with Medicare, Medicaid, third-party payer regulations, and healthcare industry standards
Perform medical record reviews, documentation analysis, and audit support activities as needed
Utilize Epic, Microsoft Office, and other healthcare systems to document, track, and manage denial activities
Communicate effectively with internal teams, payers, and stakeholders regarding claim status and appeal outcomes
Prioritize and manage multiple cases independently in a fast-paced healthcare environment while maintaining accuracy and attention to detail