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RN Clinical Appeals Specialist - Remote

Posted 1 week ago
All others
Full Time
USA
$56,800.00 - $108,900.00/year

Overview

The RN Clinical Appeals Specialist at Ensemble Health Partners plays a crucial role in managing clinically related claim denials and ensuring compliance with regulatory requirements while working collaboratively with various departments.

In Short

  • Manage appeals for clinically related claim denials.
  • Contact insurance plans to determine reasons for claim denials.
  • Analyze claims and prepare necessary appeal materials.
  • Gather additional medical documentation and resubmit claims.
  • Act as a liaison between healthcare providers for documentation clarification.
  • Work closely with departments like Case Management and HIM.
  • Ensure timely communication of denial trends and outcomes.
  • Meet regulatory compliance requirements.
  • Participate in professional development and obtain certifications.
  • Contribute to a culture of innovation and exceptional client experiences.

Requirements

  • Current unrestricted nursing license (LPN or RN).
  • CRCR or other approved certification required within 9 months of hire.
  • 1 to 3 years of relevant experience preferred.
  • Associate's Degree or equivalent experience required.
  • Proficient in Microsoft Suite.
  • Experience in hospital operations and medical record reviews.
  • Strong analytical and communication skills.
  • Ability to work collaboratively across departments.
  • Commitment to customer obsession and innovation.
  • Willingness to embrace new ideas and strive for excellence.

Benefits

  • Bonus incentives and paid certifications.
  • Tuition reimbursement for professional development.
  • Comprehensive benefits package.
  • Career advancement opportunities.
  • Recognition programs for outstanding performance.
  • Support for physical, emotional, and financial health.
  • Collaborative and innovative work culture.
  • Flexibility in work-life balance.
  • Opportunity to work with a leading healthcare organization.
  • Inclusive and diverse workplace environment.

E.R

Ensemble RCM

Ensemble Health Partners is a premier provider of technology-enabled revenue cycle management solutions tailored for health systems, including hospitals and affiliated physician groups. With a commitment to keeping communities healthy by ensuring the financial health of hospitals, Ensemble offers comprehensive end-to-end revenue cycle solutions and a suite of point solutions to clients nationwide. The company values the human touch in healthcare, emphasizing the importance of meaningful interactions and empowering its employees to challenge the status quo. Recognized for its innovative culture and dedication to professional development, Ensemble fosters an environment where associates can thrive and contribute to the organization's mission of delivering exceptional healthcare finance and revenue cycle services.

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