RN Clinical Denials Appeals Specialist

We believe in the healing power of humanity and serving the common good through our dedicated work and shared mission to celebrate humankindness. 

You have a purpose, unique talents and now is the time to embrace it, live it and put it to work. We value incredible people with incredible skills – but your commitment to a greater cause is something we value even more. This is the heartbeat of our organization and your time will be spent in a supportive, team environment with resources to help you flourish and leaders who care about your success.

The RN Clinical Denials Appeals Specialist functions as a revenue management liaison for all care sites with external third-party payers to appeal denied claims and retrospectively identifies appeals
determination as indicated through research and coordination of completion of medical records and utilization review processes. Identifies areas for documentation and/or process improvement and promotes pro-active documentation compliance for reimbursement. Demonstrates dynamic ability to adapt to ongoing changes within the health insurance industry in order to effect and implement positive changes for financial growth.
Maintains knowledge of care guidelines related to severity of illness and risk of mortality, CMS rules, and insurance regulations. Accepts and completes projects as assigned. Communicates and collaborates with other departments and maintains active presence in inpatient and outpatient settings. 

In addition to bringing humankindness to the workplace each day, qualified candidates will need the following:

Required Education:

BSN required

Minimum Experience required:

4 years clinical experience as a Registered Nurse.
3 years with progressive experience in utilization review, preferred.
Prior experience writing clinical denial appeal letters required.

License Required:

Curent RN License in the State of employment

Physical Requirements
Medium Work - exert/lift up to 50 lbs. force occasionally, and/or up to 20 lbs. frequently, and/or up to 10
lbs. constantly

*Days/hours- Monday-Friday, 8am-5pm MST*

**This is a remote role. Primary residence must be in CO, UT, or Kansas.**

Must have Clinical Denials experience. Please make sure it's clearly written out in your resume.