Clinical Denials Management Specialist

📋 Description

• Review and appeal clinical denials
• Conduct detailed account research
• Develop individualized appeal letters
• Defend clinical necessity and validity
• Address billing and charge-related denials
• Apply coding and reimbursement standards

🎯 Requirements

• Bachelor's degree in nursing, management, business, or related field required; master's degree
• Active Registered Nurse (RN) licensure and at least three years of experience as a registered nurse
• At least one year of ICU or medical-surgical unit experience, OR at least one year of demonstrated
• At least two years of utilization review/management experience using InterQual and/or MCG criteria
• Extensive knowledge of CPT, HCPCS, ICD, UB-04 revenue codes, modifiers, billing practices, and
• Strong understanding of charge capture, revenue integrity principles, and defending charges through

🎁 Benefits

• Competitive annual salary of $71,385.60 to $132,787.20
• Fully remote work
• Healthcare coverage from day one (medical, dental, vision)
• Life and disability insurance
• Paid time off
• Retirement savings plan (403(b))