Clinical Appeals Specialist

3 weeks ago


Huntsville, Texas, United States Huntsville Memorial Hospital Full time

About the Role:

Huntsville Memorial Hospital seeks a skilled Clinical Appeals Specialist to join our team. This is a unique opportunity for a registered nurse with a strong background in clinical appeals to make a meaningful impact on patient care.

Job Summary:

The Clinical Appeals Specialist will be responsible for reviewing and appealing denied medical services, ensuring that patients receive the necessary care and support. This role requires strong analytical and communication skills, as well as the ability to work effectively in a fast-paced environment.

Key Responsibilities:

  • Review medical records and determine potential for appeal on denied claims.
  • Draft appeal letters based on clinical judgment and knowledge, written in an objective narrative form.
  • Evaluate denials in terms of type, frequency, extent, site, and duration of patient's illness or injury.
  • Gather appropriate documentation, including previous determination information and complete medical records.
  • Write professional appeal letters, incorporating medically appropriate reasons for reconsideration.
  • Send appeals with attached medical records to the appropriate entity in a timely fashion.
  • Update logs for follow-up purposes and provide reports as needed.

Requirements:

To be successful in this role, you will need:

  • A graduate degree in nursing.
  • At least two years of experience in facilitating and managing appeals processes for acute care hospitals.
  • Strong analytical, data management, organizational, and time management skills.

Compensation and Benefits:

This position offers a competitive salary range of $65,000 - $85,000 per year, depending on experience. Additionally, Huntsville Memorial Hospital provides a comprehensive benefits package, including health care plan, retirement plan, life insurance, paid time off, short-term and long-term disability, training and development opportunities, and wellness resources.



  • Huntsville, Texas, United States Huntsville Memorial Hospital Full time

    Huntsville Memorial Hospital is seeking a skilled Clinical Appeals Nurse Specialist to join its team. The ideal candidate will have strong analytical, data management, and organizational skills, with a minimum of two years of experience in facilitating and managing the appeals process for acute care hospital denials.The estimated salary for this role is...


  • Huntsville, Texas, United States Huntsville Memorial Hospital Full time

    Job Title: Clinical Appeals Nurse - Denial Reconsideration SpecialistAt Huntsville Memorial Hospital, we are seeking a skilled Clinical Appeals Nurse to join our team. The ideal candidate will have a strong background in nursing and experience with denial reconsideration processes.Job SummaryWe are looking for a highly motivated and organized individual to...


  • Huntsville, Texas, United States Huntsville Memorial Hospital Full time

    We are looking for a highly skilled Denial Appeal Clinical Coordinator to join our team at Huntsville Memorial Hospital. The successful candidate will have a graduate degree in nursing and at least two years of experience in facilitating and managing the appeals process for acute care hospital denials.The estimated salary for this role is $**75,000 - $90,000...

  • Denial Appeal Nurse

    2 weeks ago


    Huntsville, Texas, United States Huntsville Memorial Hospital Full time

    Job Title: Denial Appeal NurseHuntsville Memorial Hospital is seeking a dedicated and detail-oriented Denial Appeal Nurse to join our team. As a key member of our healthcare team, you will play a vital role in ensuring that patients receive the necessary care and support.Job Summary:The Denial Appeal Nurse will be responsible for reviewing and appealing...


  • Huntsville, Texas, United States UTMB Health Full time

    Job Title: Clinical Nurse SpecialistEstimated Salary: $83,000 - $115,000 per yearNursing & Care ManagementUTMB HealthRequisition # 2403738The mission of Correctional Managed Care is to address the healthcare needs of underserved patient populations within the Texas Department of Criminal Justice (TDCJ) and the Texas Juvenile Justice Department (TJJD).About...


  • Huntsville, Texas, United States UTMB Health Full time

    Nurse Clinician III Job SummaryUTMB Health is seeking a highly skilled and experienced Clinical Nurse Specialist to join our team. As a Nurse Clinician III, you will provide direct nursing care to an assigned group of patients and possess knowledge and skill to meet standards for competent professional nursing practice as specified in the Texas Nurse...


  • Huntsville, Texas, United States Huntsville Memorial Hospital Full time

    Huntsville Memorial Hospital is seeking an experienced Medical Reconsideration Reviewer to join its team. The ideal candidate will have a strong background in nursing, with a minimum of two years of experience in facilitating and managing the appeals process for acute care hospital denials.The estimated salary for this role is $**75,000 - $90,000 per year**,...


  • Huntsville, Texas, United States Morrison Healthcare Full time

    About Morrison HealthcareMorrison Healthcare is a member of Compass Group USA, a leading national food and nutrition services company.With over 600 hospitals and healthcare systems served, we provide socially responsible practices and exceptional guest experiences through our hospital kitchens, restaurants, and cafés.Salary and BenefitsThe estimated annual...


  • Huntsville, Texas, United States Believe Therapies LLC Full time

    Job Title: Occupational Therapist RegisteredAbout Believe Therapies LLC:We are a multidisciplinary team dedicated to providing high-quality care to our clients. Our goal is to create a supportive and collaborative environment where our employees can thrive.Job Description:Salary: $34-$52 per hour (based on experience)Develop and manage occupational therapy...


  • Huntsville, Texas, United States Sam Houston State Full time

    Job OverviewAs a skilled Clerical Operations Specialist at Sam Houston State, you will play a vital role in maintaining the smooth operation of our clinical practice. This position requires exceptional organizational and communication skills to ensure seamless interactions with patients, staff, and other stakeholders.Estimated Salary: $45,000 - $60,000 per...

  • Nurse Specialist

    1 week ago


    Huntsville, Texas, United States Huntsville Memorial Hospital Full time

    **Job Title:** Nurse Specialist - Medical UnitHuntsville Memorial Hospital is seeking a skilled and compassionate Nurse Specialist to join our medical team in the Intensive Care Unit (ICU). As a member of our ICU team, you will be responsible for providing high-quality patient care, utilizing your expertise and knowledge to ensure the best possible outcomes...


  • Huntsville, Texas, United States UTMB Health Full time

    About UTMB HealthUTMB Health is a leading healthcare provider dedicated to delivering exceptional patient care and promoting healthy communities.


  • Huntsville, Texas, United States Huntsville Memorial Hospital Full time

    Job OverviewHuntsville Memorial Hospital seeks a skilled Respiratory Therapist to join our Cardiopulmonary Services Department. The successful candidate will be responsible for providing high-quality patient care and performing technical procedures related to respiratory therapy.Key ResponsibilitiesAdminister therapeutic modalities, including aerosol...


  • Huntsville, Texas, United States AccentCare, Inc. Full time

    About the RoleWe are seeking a Compassionate Spiritual Support Specialist to join our team at AccentCare, Inc.In this role, you will provide one-on-one spiritual support to patients and their families, particularly during end-of-life and bereavement processes. You will assess spiritual needs, develop care plans under physician guidance, and collaborate with...

  • RN Clinician III

    3 weeks ago


    Huntsville, Texas, United States UTMB Health Full time

    Job Summary:The Clinical Nurse Specialist provides direct nursing care to an assigned group of patients in a correctional setting. The ideal candidate will possess strong clinical skills, excellent communication abilities, and the ability to work effectively in a fast-paced environment.Responsibilities:Assess, plan, implement, evaluate, and document the...


  • Huntsville, Texas, United States Believe Therapies LLC Full time

    Key Responsibilities:Deliver speech therapy treatment to clients and report resultsMaintain accurate records of treatment and progressDevelop and implement effective interventions using evidence-based practicesProvide high-quality care and support to clients and familiesWork collaboratively with healthcare professionals and provide education and training as...


  • Huntsville, Texas, United States Believe Therapies LLC Full time

    Company OverviewBecome a part of Believe Therapies LLC, where our mission is to create the best life for everyone. We believe in transparency, a positive work environment, opportunity, supportive administration, and faith. Our purpose is to improve functional levels through therapy services.We are committed to delivering high-quality care through our values:...


  • Huntsville, Texas, United States UTMB Health Full time

    Job SummaryWe are seeking a competent clinician to provide direct nursing care to patients in an assigned group. The ideal candidate will possess knowledge and skill to meet standards for competent professional nursing practice as specified in the Texas Nurse Practice Act.The successful candidate will competently function as a member of an interdisciplinary...


  • Huntsville, Alabama, United States SportsMED Orthopaedic Specialist, INC Full time

    Clinical Assistant PositionSportsMED Orthopaedic Specialist, INC invites applications from motivated and compassionate individuals to fill the role of Certified Medical Assistant.Estimated Salary: $70,000 - $90,000 per year.Main ResponsibilitiesSupport healthcare professionals in providing high-quality patient care, adhering to established protocols and...


  • Huntsville, Alabama, United States SportsMED Orthopaedic Specialist, INC Full time

    About UsSportsMED Orthopaedic Specialist, INC is a leading provider of orthopedic services in the region. Our team is passionate about delivering high-quality care and promoting healthy lifestyles through education and community outreach.Job DescriptionWe are seeking a detail-oriented Registered Nurse and Certified Medical Assistant (RN-CMA) to join our PRN...


  • Huntsville, Alabama, United States SportsMED Orthopaedic Specialist, INC Full time

    Company OverviewSportsMED Orthopaedic Specialist, INC is a reputable healthcare provider dedicated to delivering exceptional orthopedic care. Our team of skilled professionals is committed to providing patients with the highest level of service and treatment.Job SummaryWe are currently seeking a highly motivated Registered Nurse and Certified Medical...


  • Huntsville, Alabama, United States SportsMED Orthopaedic Specialist, INC Full time

    Job SummarySportsMED Orthopaedic Specialist, INC is seeking a skilled Certified Medical Assistant to join our team. The successful applicant will possess strong technical skills, excellent communication abilities, and a passion for delivering top-notch patient care.This role offers a challenging and rewarding opportunity to work in a dynamic environment. The...


  • Huntsville, Alabama, United States Huntsville Hospital Health System Full time

    Job OverviewWe are seeking a skilled Clinical Support Specialist to join our team at Huntsville Hospital Health System. In this role, you will work collaboratively with the clinical team to provide high-quality patient care.The ideal candidate will have a high school diploma or equivalent and experience working in a clinic setting. A certified medical...


  • Huntsville, Alabama, United States HH Health System Full time

    Job SummaryWe are seeking a highly skilled Clinical Informatics Specialist to join our team at HH Health System. In this role, you will be responsible for leading the development and implementation of clinical informatics programs, ensuring seamless integration with existing systems.The successful candidate will possess strong leadership skills, excellent...


  • Huntsville, Alabama, United States Thermo Fisher Scientific Full time

    About the RoleWe are currently hiring for a Clinical Support Specialist level I or II at our Huntsville, AL site. The successful candidate will be responsible for performing technical procedures at the site, including vital signs, blood collection, height, weight, electrocardiogram, etc., as per local regulations. They will also perform non-technical...


  • Huntsville, Alabama, United States HudsonAlpha Institute for Biotechnology Full time

    We are seeking a highly skilled Clinical Laboratory Specialist to join our team at HudsonAlpha Institute for Biotechnology. This is a full-time position with an estimated salary of $45,000 - $60,000 per year.The successful candidate will have experience in clinical sample manipulation, polymerase chain reaction (PCR) amplification, and pipetting. They will...


  • Huntsville, Alabama, United States Huntsville Hospital Full time

    Job DescriptionWe are seeking a skilled Clinical Nurse Specialist to join our team at Huntsville Hospital. This is a full-time position working 1st shift.The ideal candidate will have a minimum of five years critical care experience and extensive computer skills, proven teaching/training skills, and team leadership skills. They will be able to adapt to a...


  • Huntsville, Alabama, United States Walmart Full time

    About the RoleWe are seeking a skilled Cake Decorator Specialist to join our team at Sam's Club in Huntsville, AL. As a key member of our bakery production team, you will be responsible for creating visually appealing cakes and pastries that meet our high standards of quality and consistency.Your primary goal will be to drive sales growth by delivering an...


  • Huntsville, Alabama, United States SportsMED Orthopaedic Specialist, INC Full time

    About the RoleWe are seeking a detail-oriented and organized Certified Medical Assistant to join our team at SportsMED Orthopaedic Specialist, INC.Estimated Salary: $65,000 - $85,000 per year.Key ResponsibilitiesDeliver high-quality patient care and services, adhering to industry standards and regulations.Manage patient records and maintain confidentiality,...


  • Huntsville, Alabama, United States beBee Professionals Full time $45,000 - $65,000

    As an Advanced Clinical Healthcare Specialist with beBee Professionals in Huntsville, United States, you will play a vital role in providing top-notch healthcare services in various clinical settings. Your primary responsibility will be to work closely with patients, nurses, and doctors to ensure seamless patient care.Responsibilities:Monitor patient health...


  • Huntsville, Alabama, United States SportsMED Orthopaedic Specialist, INC Full time

    Job SummarySportsMED Orthopaedic Surgery & Spine Center is seeking experienced professionals to fill full-time and part-time X-Ray Technologist positions at our Huntsville Office.We are looking for candidates with a minimum of 2 years of experience as certified X-Ray Technologists who can work in a clinical setting and urgent care environment.


  • Huntsville, Alabama, United States Theravolve Full time

    About the JobTheravolve is seeking a highly skilled Clinical Administrative Specialist to join our team. As a key member of our operations, you will play a critical role in ensuring the smooth processing of medical billing and accounts receivable.ResponsibilitiesWork independently to manage assigned accounts, maintaining accurate and up-to-date...


  • Huntsville, Alabama, United States beBee Professionals Full time $30,000 - $45,000

    Job DescriptionWe are seeking a highly skilled Clinical Healthcare Support Specialist to join our team in Huntsville.About the RoleProvide essential support in healthcare settings by assisting with patient care and administrative tasks.Responsibilities:Taking patient histories and preparing them for examinations.Assisting healthcare providers during...


  • Huntsville, Alabama, United States Wellstone Inc Full time

    Job Title: Clinical Nurse SpecialistAbout Us: WellStone Inc is a comprehensive behavioral healthcare provider serving over 13,000 persons a year in Northern Alabama. We are committed to providing quality care through adherence to established standards of care and facility policies, procedures and protocols.Job Summary: The Registered Nurse will evaluate...


  • Huntsville, Alabama, United States Huntsville Hospital Full time

    Overview of a Rewarding Career at Huntsville HospitalHuntsville Hospital is committed to providing the best possible care to our patients, and we are seeking a highly skilled Clinical Nurse Specialist to join our team in the Pre Admission Center. As a member of our team, you will have the opportunity to work in a fast-paced environment and make a real...

  • Clinical Practitioner

    3 weeks ago


    Huntsville, Alabama, United States The Orthopaedic Center Full time

    The Orthopaedic Center invites applications from qualified candidates for the position of Clinical Practitioner. As a vital member of our orthopaedic care team, you will provide expert patient care while collaborating with our specialists to deliver exceptional outcomes.Key responsibilities will include:Serving as a surgical first assistant and participating...


  • Huntsville, Alabama, United States Veterans Affairs, Veterans Health Administration Full time

    **Job Description**The Clinical Pharmacy Specialist will provide advanced clinical pharmacy services to patients in the oncology department. This includes developing and implementing individualized pharmacotherapy plans, coordinating patient care, and maintaining accurate patient records.**Key Responsibilities**Direct Patient Care: Provide expert clinical...


  • Huntsville, Alabama, United States SportsMED Orthopaedic Specialist, INC Full time

    We are currently seeking a detail-oriented Certified Medical Assistant to join our team at SportsMED Complete Orthopedic Care. In this role, you will have the opportunity to utilize your clinical skills and knowledge to deliver high-quality patient care.The successful candidate will have excellent communication and interpersonal skills, as well as the...