The Denials Management Appeals Nurse manages medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted, utilizing his/her clinical background to address the clinical denials and will write sound, compelling factual arguments for appealing denials, maintaining a detailed knowledge of Third Party Payors and Governmental Payors clinical/medical necessity criteria.
Job listings
$80,000–$85,000
USD/year
As a registered nurse in Illinois, you will work remotely to enhance member management quality, maximize satisfaction and cost effectiveness, and help members navigate the health system as a collaborative health partner. You'll work closely with clients and members to promote wellness, problem-solve, and assist members in achieving their personal health-care related goals.