Registered Nurse - Clinical Appeals

Job Summary

A company is looking for a Registered Nurse - Clinical Denials/Appeals - Remote.

Key Responsibilities

• Review and analyze clinical denials from insurance companies and third-party payers
• Conduct comprehensive denial root-cause analysis and ensure documentation integrity
• Coordinate pre-service authorization approvals and construct warranted appeals

Required Qualifications

• Bachelor's Degree (relevant experience may substitute formal education)
• Current Registered Nursing License
• 4+ years of prior clinical experience
• 1+ years of experience in post-claim clinical appeals
• Familiarity with medical records assembly and clinical terminology