US Registered Nurse | Denials and Appeals | Pioneer | WFH after trainingAccess Healthcare is looking USRN with Denials and appeals experience!
You'll be responsible for reviewing clinical documentation, analyzing payer denials, and writing appeal letters to overturn inappropriate denials.
This role requires strong analytical, clinical, and communication skills, as well as a solid understanding of insurance guidelines and medical necessity criteria.
Key Responsibilities:
- Review clinical records and insurance denial letters to determine the validity and potential for appeal.
- Prepare comprehensive and persuasive appeals letters in alignment with payer policies, medical guidelines, and regulatory standards.
- Collaborate with physicians, case managers, coders, and other healthcare professionals to gather supporting documentation.
- Monitor appeal outcomes and trends; provide feedback to improve denial management strategies.
- Maintain up-to-date knowledge of payer requirements, federal/state regulations, and clinical guidelines ( InterQual, MCG, LCD NCD )
- Ensure all documentation is accurate, timely, and compliant with HIPAA and internal policies.