Remote Clinical Appeals RN

Job Description

Job Description

Clinical Appeals RN – 100% Remote

$40-$50/hour | Part-Time & Full-Time Opportunities Available

Our team partners with healthcare providers and hospital organizations to deliver revenue cycle and accounts receivable support services. If you thrive in a fast-paced environment, enjoy problem solving, and have experience appealing denied claims, we'd love to hear from you. 

As a Remote Clinical Appeals RN, you'll use your clinical expertise to review and appeal insurance denials related to lack of authorization and medical necessity. You'll work with healthcare providers and insurance companies to support the clinical appeals process and advocate for appropriate coverage of medically necessary services.

We're looking for an experienced nurse who can hit the ground running and work independently with minimal training. 

Position Details:

• Pay: $40-50/hour, depends on experience 

• Schedule: Part-time (20 hours/week) or full-time (40 hours/week)

• Location: 100% Remote

• Employment Type: Temporary, with the potential to become permanent

What You’ll Do: 

• Review insurance denials and clinical appeals thoroughly and accurately.

• Advocate for patients and healthcare providers by communicating and negotiating with insurance companies.

• Apply clinical knowledge to evaluate medical records, identify denial issues, and develop effective appeals.

• Collaborate with team members to gather supporting documentation and information needed for appeals.

• Prepare and submit clinical appeals accurately and within required deadlines.

• Maintain detailed, organized records of denials, appeals, and outcomes.

• Stay informed about insurance policies, payer requirements, and applicable regulations to ensure compliance.

• Communicate effectively with healthcare providers, insurance companies, and other stakeholders regarding denial and appeal status.

• Track appeal outcomes, monitor success rates, and identify opportunities for improvement.

• Ensure all activities comply with ethical, legal, and HIPAA confidentiality requirements.

• Participate in team meetings and discussions related to denial management and appeals.

• Identify opportunities to improve workflows, processes, and overall efficiency.

• Provide timely and accurate reporting on denials, appeals, and outcomes to management.

Experience & Education:

• Bachelor’s degree in Nursing, Health Administration, or a related field.

• Advanced clinical credentials or degrees (e.g., RN, NP, or PA) preferred.

• Minimum of 2 years of clinical experience in a healthcare setting.

• Experience in clinical appeals, prior authorizations, utilization review, or case management highly desirable.

Skills & Qualifications:

• Strong clinical knowledge and the ability to interpret medical records and clinical documentation.

• Excellent written and verbal communication skills, including the ability to communicate effectively with insurance companies and healthcare providers.

• Strong attention to detail, organization, and time management.

• Proficiency with electronic health records (EHRs) and other healthcare-related software.

• Ability to manage multiple appeals, meet deadlines, and work independently.

• Strong problem-solving and critical-thinking skills.