New York Licensed Clinical Denials Specialist

Job Summary

A company is looking for a Clinical Denials & Appeals Specialist (Remote).

Key Responsibilities

• Reviews denial trends and identifies coding issues and knowledge gaps
• Serves as a liaison between patients, facilities, and third-party payers to facilitate appropriate level of care decisions
• Conducts clinical reviews and formulates appeal letters to support medical necessity and appropriateness of care

Required Qualifications

• Graduate from an accredited School of Nursing
• Bachelor's Degree in Nursing is preferred
• Must be enrolled in an accredited BSN program within two years and obtain a BSN Degree within five years of job entry date
• Current License to practice as a Registered Professional Nurse in New York State is required
• Specialized certifications as needed