Clinical Appeals Specialist, RN
Overview:** Xtend Healthcare is seeking a Clinical Appeals Specialist, RN to work collaboratively with project leaders and clients to assist healthcare providers in evaluating, reporting, and providing recommendations on denied or underpaid claims. This remote position requires a registered nurse with five years of experience in utilization review and electronic health record expertise... **Responsibilities:** Evaluate, report findings, and provide recommendations on denied or underpaid claims Assist in identifying, complying, and reversing denials from payers Work closely with client departments to review and obtain medical documentation for denial appeals Compile, analyze, and report on data related to underpayments, denials, revenue opportunities, and revenue leakage Serve as a resource for billing and reimbursement questions requiring clinical knowledge and medical records review and interpretation Continuously review and update knowledge of relevant regulations Perform other duties as assigned related to clinical review and patient care management *Qualifications:** Bachelor's degree in Nursing, Business, Health Information, Clinical Studies, or Registered Nurse (RN) from an accredited institution Five years' experience as an RN, including utilization review experience Electronic health record (EHR) expertise, including knowledge of various vendors Reliable high-speed internet, cell phone, and computer equipment Private workspace or home office free from distractions *Benefits:** Competitive salary and benefits package Opportunity to work with a leading revenue cycle management company Collaborative and dynamic work environment Professional development and growth opportunities Comprehensive training program Equal Opportunity Employer with a commitment to diversity and inclusion
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