RN Coor Clinical Denial Recovery/Full Time/Remote

Under minimal supervision, this RN specializes in follow-up of denied and rejected claims from all commercial, contracted and non-contracted payers, including preparing appeal letters. Working within a centralized department, reviews all denials for medical necessity and appeal ability utilizing clinical judgment and applying appropriate medical necessity criteria. Provides clinical utilization management expertise to provide education, formal and informal and facilitates denial management strategies. Serves as a liaison to key customers that include, hospital ancillary departments, physicians, and payers.