Clinical Government Audit Analyst and Appeal Specialist II (RN) - Remote

Overview

The Clinical Government Audit Analyst and Appeal Specialist II plays a critical role in managing and resolving clinical appeals related to government audits and denials, requiring strong clinical acumen and excellent analytical skills.

In Short

• Conduct denial analysis and ensure accurate coding.
• Compose professional appeal letters to payors.
• Develop comprehensive appeal strategies based on guidelines.
• Draft and submit detailed appeal letters with supporting documentation.
• Provide appealability scores for denials under review.
• Collaborate with clinical teams and coding specialists.
• Stay updated on healthcare regulations and payor policies.
• Participate in developing appeal templates and audit tools.
• Manage deadlines and communicate proactively.
• Maintain confidentiality of sensitive information.

Requirements

• Bachelor’s degree in nursing required.
• Minimum two years of progressive denials and appeals experience.
• Knowledge of medical and insurance terminology.
• Proficiency in computer systems, specifically EPIC and 3M.
• Ability to communicate effectively in written and verbal formats.
• Strong analytical and critical thinking skills.
• Ability to manage multiple tasks and adapt to changing priorities.
• Ability to influence outcomes through data-supported arguments.
• Licenses and certifications in coding required within 180 days.
• Registered Nurse licensure preferred.

Benefits

• Opportunity to work in a leading healthcare organization.
• Engagement in innovative healthcare practices.
• Support for professional development and training.
• Collaboration with a diverse and skilled team.
• Commitment to providing exceptional patient and family experiences.