Appeals Nurse

Atlantic Region CBO Appeals Nurse

The Atlantic Region CBO is seeking a dynamic and talented Appeals Nurse with clinical case management experience, to analyze clinical claim denials, draft detailed appeal letters, evaluate clinical level of care and review denial trends. Key responsibilities include:

• Perform clinical reviews in response to claim denials by third party payers
• Analyze medical records to confirm medical necessity as it pertains to inpatient level of care, readmissions, patient length of stay, non-covered services, experimental and investigational issues, ER downgrades, DRG validation and other claim denials
• Draft detailed clinical appeal letters to submit to third party payers to obtain reimbursement for denied claims
• Make decisions to downgrade inpatient claims to observation status and perform calculation of observation hours
• Call third party payers and physician offices as needed to obtain additional clinical details, retro-authorization requests, and clarity on denials
• Identify denial trends and provide feedback to management and to UHS acute care facilities
• Adhere to all applicable laws, regulations, and guidelines
• Provide clinical knowledge for CBO staff and consultation to management as needed

Other duties as assigned.

Benefit & Rewards Highlights:

• Challenging and rewarding work environment
• Competitive compensation & generous paid time off
• Excellent medical, dental, vision and prescription drug plans
• 401(k) with company match and discounted stock plan
• SoFi student loan refinancing program
• Career development opportunities within UHS and its 300+ subsidiaries!
• Pet insurance

About Universal Health Services:

One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500 corporation, annual revenues during 2025 were $17.4 billion. In 2026, UHS was again recognized as one of Fortune World's Most Admired Companies and in 2025, was listed in Forbes ranking of America's Largest Public Companies. Headquartered in King of Prussia, PA, UHS has approximately 101,500 employees and continues to grow through its subsidiaries. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located in 40 U.S. states, Washington, D.C., Puerto Rico and the United Kingdom.

Qualifications Position Requirements:

• RN or LPN licensure in good standing is required
• Three to five years of experience is preferred
• Ability to work effectively with payers, patients, clinicians, HIM and other employees
• Experience working in patient financial services and an understanding of the revenue cycle from beginning to end is preferred
• Experience working in case management or audit and with technical denials is preferred
• Ability to communicate clearly and concisely both verbally and in writing
• Proactively prioritizes and effectively manages resources
• Must be detail oriented with the ability to multi-task
• Strong Microsoft Office skills (Excel, Word, Outlook)
• Customer focused both internally and externally, strong attention to detail, the ability to multi-task
• Excellent written and oral communication skills are required

EEO Statement: All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.