Nurse Specialist - Clinical Denials and Appeals
Huron
Chicago
Workplace: RemoteFull timeUSD 33.65 - 43.27 hourlyFunction: Healthcare (Clinical, Medical, Wellness)Experience: 3-5 yearsEducation: associatesSkills: ["Strong oral and written communication","Strong analytical and critical thinking","Ability to work independently","Self-motivated","Attention to detail"]Review denied claims and manage the clinical denials and appeals process for IP & OP payor requirements. Conduct medical necessity reviews, draft and submit written appeals with clinical documentation and policy/contract support, and track outcomes. Maintain denial data and identify patterns to recommend process improvements to reduce A/R. Ensure compliance with state/federal regulations and HIPAA while communicating effectively across teams.
