About this opportunity
Capital Health (US) lists this Clinical Appeals RN: Denials & Reimbursement Specialist opportunity in lawrenceville, Illinois. Review the employer’s description below for duties, qualifications and application requirements.
Job description
Capital Health is seeking a Utilization Review/Denials Specialist to lead clinical appeals for denied inpatient and outpatient claims. You will apply MCG criteria and payer policies to support medical necessity and maximize reimbursement, working with physicians, CDI, UR, and non-clinical denial staff.
The role requires a registered nurse with at least three years of clinical nursing experience and knowledge of medical record documentation.
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Who can apply
Review the original listing for work authorization, qualifications and employer requirements.