Arizona Licensed RN Denial Specialist

To support the denial management process, the full-time Arizona Licensed RN Denial Specialist will analyze medical records, craft clinical appeals, and collaborate with payers to secure reimbursement while working remotely during standard business hours. Key responsibilities Provide clinical expertise and oversight in the denial management process, including responding to audit requests and preparing appeals Evaluate coverage issues, payor outliers, and compliance issues to ensure accurate billing and reduce denials Quantify and analyze industry trends to recommend improvements that enhance financial outcomes for the organization Required qualifications Active Registered Nurse (R.N.) licensure in the state of practice A minimum of 5 years of clinical nursing experience, preferably in Case Management or Utilization Review Experience with federal, state, and commercial reimbursement processes and auditing DRG coding Proficiency in office desktop software programs Strong critical thinking and problem-solving skills