RN Clinical Denial Recover Analyst | Enterprise Denials

Overview

Turn clinical expertise into stronger appeals, better reimbursement, and fewer denials across the enterprise.

Work Style: Remote
Location Requirement: Must reside in an authorized state (FL, GA, PA, NC, SC, TN, or TX)
FTE: Full-Time (1.0 FTE)

The Clinical Denial Management Nurse is responsible for completing, tracking, and reporting clinical denials across all UF hospitals at an enterprise level. Reporting to the Enterprise Denial Nurse Manager, this role supports key revenue cycle functions including clinical departments, finance, accounting, compliance, patient financial services, revenue integrity, managed care, utilization review, and patient access.

Serves as a clinical expert in denial management, reviewing denied claims from a clinical perspective and developing effective appeal strategies. Ensures appropriate documentation and submission of appeals to maximize reimbursement and minimize organizational write-offs.

Collaborates with cross-functional teams to identify denial trends, improve processes, and support enterprise-wide initiatives that enhance revenue cycle performance and compliance.

Responsibilities

Key Responsibilities

• Review, track, and manage clinical denials and appeals to support reimbursement optimization and minimize organizational write-offs.
• Analyze denied claims from a clinical perspective and prepare accurate, well-supported appeals.
• Collaborate with revenue cycle, finance, compliance, managed care, utilization review, patient access, and clinical departments to resolve denial issues.
• Research payer policies, contracts, EOBs, and reimbursement guidelines to support claim resolution activities.
• Monitor denial trends and identify opportunities for process improvement and denial prevention.
• Maintain compliance with Medicare, Medicaid, third-party payer regulations, and healthcare industry standards.
• Perform medical record reviews, documentation analysis, and audit support activities as needed.
• Utilize Epic, Microsoft Office, and other healthcare systems to document, track, and manage denial activities.
• Communicate effectively with internal teams, payers, and stakeholders regarding claim status and appeal outcomes.
• Prioritize and manage multiple cases independently in a fast-paced healthcare environment while maintaining accuracy and attention to detail.

Qualifications

Education

• High School Diploma or GED required.
• Bachelor’s Degree in Nursing (BSN) preferred.
• Licensed to practice nursing as a Registered Nurse (RN) or Licensed Practical Nurse (LPN) in the State of Florida required.

Experience & Skills

• CPC, COC, RHIT, RHIA, or CCS certification preferred.
• Two (2) to three (3) years of clinical experience as a Registered Nurse (RN) required; OR three (3) to five (5) years of clinical experience as a Licensed Practical Nurse (LPN) required.
• Knowledge of or experience related to coding, medical record review, auditing, or insurance processes preferred.