Clinical Denials Specialist

🕒 June 25

🇺🇸 United States – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 43%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Healthrise

WebsiteLinkedInAll Job Openings

51 - 200 employees

🏥 Healthcare

⚖️ Legal

📦 Logistics

Healthcare • Legal • Logistics

Healthrise is a company dedicated to providing comprehensive healthcare solutions, focusing on revenue cycle management, electronic health record (EHR) services, and strategic consulting. With over a decade of experience, Healthrise assists health systems nationwide in achieving operational and financial success through tailored strategies. Their team of experts partners with healthcare organizations to tackle complex operational challenges and enhance efficiency, ensuring both patient and financial outcomes are optimized.

📋 Description

• Ability to analyze denial reasons and trends to identify opportunities for process improvement. • Excellent verbal and written communication skills to effectively collaborate with healthcare providers and present appeal arguments. • Keen attention to detail to ensure accurate review and analysis of denied claims and medical records. • Strong problem-solving skills to develop effective appeal strategies and overcome denial challenges. • Understanding of medical terminology, coding principles, and reimbursement guidelines to assess denial reasons and appeal opportunities. • Ability to adapt to changing payer policies, regulations, and reimbursement requirements. • Review denied claims to identify denial reasons and discrepancies. • Analyze medical records, billing documents, and payer policies to prepare appeal arguments. • Collaborate with healthcare providers to gather additional documentation and evidence for appeals. • Document appeal activities, correspondence, and outcomes for tracking and reporting purposes. • Monitor denial trends and provide feedback to revenue cycle teams to prevent future denials. • Participate in denial management meetings and contribute insights to improve denial prevention strategies. • Stay updated on payer policies, regulations, and reimbursement guidelines relevant to claim denials.

🎯 Requirements

• Bachelor's degree in healthcare administration, nursing, health information management, or a related field. • Clinical designated nurse, RN credentials (denials/CDI) • Minimum of 2-3 years of experience in healthcare revenue cycle management, medical billing, claims processing, or denial management.