Outpatient Denial/Appeals Specialist RN

3 weeks ago


Urbana, Illinois, United States Carle Health Full time
Job Summary

We are seeking a highly skilled Outpatient Denial/Appeals Specialist RN to join our team at Carle Health. As a key member of our revenue cycle team, you will be responsible for reviewing and appealing outpatient denials, ensuring accurate and timely reimbursement for our patients.

Key Responsibilities
  • Conduct thorough clinical reviews to establish medical necessity for outpatient services
  • Develop and implement effective denial and prior authorization appeal strategies
  • Collaborate with coding and physicians to improve documentation and support medical necessity
  • Represent Carle Health in clinical meetings and appeals processes
  • Monitor and analyze accounts receivable to optimize collection
  • Participate in system testing and development to improve revenue cycle processes
Requirements
  • Bachelor's Degree in Nursing
  • Three years of experience in healthcare with a focus on reimbursement and/or case management
  • Proficient in Microsoft Office applications and Epic reporting tools
  • Excellent communication, negotiation, and problem-solving skills
What We Offer

At Carle Health, we offer a dynamic and supportive work environment, competitive compensation and benefits, and opportunities for professional growth and development. If you are a motivated and detail-oriented individual with a passion for revenue cycle management, we encourage you to apply for this exciting opportunity.



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