Access Healthcare is looking USRN with Denials and appeals experience!

You will 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 (e.g., InterQual, MCG).
• Ensure all documentation is accurate, timely, and compliant with HIPAA and internal policies.

Qualifications:

• Active USRN license
• At least 2 years of hospital experience.
• At least 1 year in Utilization Review, Denials Management, or Appeals Writing.
• Must have experience/knowledge in Oncology
• Strong understanding of medical necessity, clinical guidelines (e.g., InterQual, MCG), and payer requirements.
• Excellent written communication and critical thinking skills.
• Experience working with EMRs, UM software, and payer portals.

WFH AFTER TRAINING!

Please refer to job description.