State Licensed Clinical Denial Specialist

Key responsibilities: Manage timely reviews and responses to hospital billing audits and appeals Prepare and submit detailed clinical appeals while collaborating with clinical and coding teams Evaluate patient medical records to ensure accuracy in documentation and billing

Required qualifications: Associate degree in healthcare administration, Nursing, Health Information Management, or related field with five years of relevant experience, or a Bachelor's degree with three years of experience Current state-issued Registered Nurse or Licensed Practical Nurse license, or relevant certification (RHIT, RHIA, CCDS, CDIP, CCS, CIC) Experience in hospital billing, acute care settings, CDI, inpatient coding, or revenue cycle Strong knowledge of CMS guidelines, coding rules, and clinical standards Ability to work independently with minimal supervision while maintaining current clinical and coding knowledge