Clinical Denials and Appeals Specialist - Remote

Overview

This role focuses on tackling complex issues related to clinical denials and appeals within the US healthcare system, aiming to empower patients and improve their access to necessary care.

In Short

• Tackle complex, high-impact problems in clinical denials, appeals, and insurance coverage decisions.
• Apply clinical expertise to review medical records and craft compelling appeals.
• Continuously learn about health insurance policies and regulatory frameworks.
• Support healthcare advocates by preparing strong clinical appeals and documentation reviews.
• Shape operations in a fast-moving environment with your clinical perspective.
• Gain deep expertise in US healthcare and its systemic challenges.
• Champion diverse perspectives for more inclusive solutions.
• Collaborate daily with a team of healthcare advocates.

Requirements

• Bring clinical expertise - RN or LVN with experience in utilization review, appeals, or medical necessity documentation.
• In-depth understanding of healthcare in the US.
• Passionate about health equity.
• Strong communicator capable of distilling clinical information.
• Thrive in ambiguity and navigate unclear denial scenarios.
• Have a bias for action and high output.
• Mission-driven and excited to make a real impact.

Benefits

• Work in a split team between in-office culture and remote-first practices.
• Engage in a mission-driven environment focused on making a difference.
• Be part of a well-funded early-stage company with significant backing.
• Collaborate with passionate individuals committed to excellence.
• Opportunities for continuous learning and professional growth.