Hybrid Clinical Appeals Nurse
: Job Details :

Hybrid position, in Annapolis, MD. Onsite 2 days a week, remote 3 days a week.

Qualifications:

• At least three years of experience required in one of the following areas: clinical, case management, denials, billing
• Previous experience as an acute RN preferred
• Registered nurse (RN) licensure required, bachelor's degree in nursing preferred
• Certification in at least one of the following preferred: certified healthcare chart auditor, certified professional in utilization review (or utilization management or healthcare management), certified case manager, certified documentation specialist, certified coder, certified professional medical auditor, or similar program

Position Summary

The clinical denial appeals specialist is responsible for the identification, mitigation, and prevention of clinical denials. This staff member reviews all initial clinical denials to determine next steps and conducts appeals as appropriate, such as by reviewing medical necessity, responding to authorization concerns, and/or reconciling coverage-related issues. The clinical denial appeals specialist also works to prevent future clinical denials by communicating with clinical and revenue cycle leadership about denial root causes, such as documentation gaps or insufficient charge capture, and helps develop and implement staff education and process changes.

Pay: $83,200.00 - $124,800.00 per year (Based on experience, education, certifications, etc). Benefits offered by employer!