Clinical Nurse Specialist

🔥 0 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $68k - $100k / year

⏰ Full Time

🟢 Junior

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Aspirion

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2006

⚕️ Healthcare Insurance

🤖 Artificial Intelligence

☁️ SaaS

💰 Series unknown on 2012-02

Healthcare Insurance • Artificial Intelligence • SaaS

Aspirion is a healthcare revenue cycle management company that helps hospitals recover revenue from denied and complex claims. The company deploys AI automation and a proprietary Compass platform, staffed with US-based attorneys, clinicians, and AI engineers, to overturn clinical denials, maximize out-of-network reimbursement, perform zero-balance reviews, and recover payment variances across services such as denials management, AR management, complex claims, motor vehicle accidents, workers' compensation, TRICARE, and out-of-state Medicaid. Aspirion emphasizes measurable recovery impact (over $6 billion captured), increased collections for clients, HITRUST certification, Best in KLAS awards, and partnerships with large health systems.

📋 Description

• Review and analyze medical records and denial rationale to develop clinically supported appeal arguments • Interpret and apply clinical guidelines (e.g., InterQual, Milliman) to support medical necessity determinations • Prepare, edit, and enhance appeals using internal tools (e.g., DOCIQ) • Accurately assign denial root causes and complete nurse review reporting • Identify denial trends and escalate insights to support prevention strategies and process improvement • Document all case activity clearly within internal and client systems • Participate in quality control reviews and provide feedback to improve appeal effectiveness • Serve as a clinical subject matter expert for team members and cross-functional partners • Support onboarding, training, and ongoing education for clinical staff • Collaborate with operations and leadership to meet client expectations and performance goals • Maintain productivity and quality standards in a metrics-driven environment

🎯 Requirements

• Active LPN or RN license (required) • 1+ year experience in utilization review, case management, or clinical denials • 1+ year experience resolving hospital clinical denials • Acute care clinical experience preferred • Certification in Case Management or Utilization Review preferred • Strong clinical reasoning and critical thinking skills • Ability to interpret medical documentation and payer guidelines • Knowledge of utilization management and medical necessity criteria (e.g., InterQual, Milliman) • Strong written communication skills for persuasive clinical appeals • Attention to detail with ability to manage multiple priorities • Proficiency with EMRs and healthcare systems • Ability to work independently and collaboratively in a fast-paced environment

🏖️ Benefits

• Not specified