Denial Management Professional

2 days ago


Melville, New York, United States Northwell Health Full time
Job Overview

We are seeking an experienced nurse to fill the role of Clinical Denials Specialist at Northwell Health. As a key member of our team, you will be responsible for reviewing denial trends, identifying coding issues, and collaborating with healthcare professionals to resolve disputes.

About the Job
  • Work Schedule: Remote work schedule (Sun-Thurs, 8AM-4PM)

This position requires a strong understanding of regulatory standards, clinical protocols, and business operations. Your ability to analyze complex data, identify patterns, and develop strategic solutions will be essential in driving operational efficiency and improving patient outcomes.

Key Responsibilities
  1. Clinical Expertise: Leverage your nursing background to provide expert guidance on medical necessity, coding, and billing procedures.
  2. Communication Skills: Effectively collaborate with healthcare teams, payers, and patients to resolve disputes and improve communication channels.
  3. Process Improvement: Analyze existing workflows, identify areas for improvement, and implement data-driven solutions to optimize operational efficiency.
  4. Regulatory Compliance: Ensure adherence to relevant laws, regulations, and industry standards, maintaining the highest level of integrity and professionalism.
Requirements and Qualifications
  • Nursing Education: Bachelor's Degree in Nursing or equivalent required; Master's Degree preferred.
  • Licensure: Current License to practice as a Registered Professional Nurse in New York State required, plus specialized certifications as needed.
  • Experience: Prior experience in Case Management, Utilization Review, and Appeals/Denials highly preferred.
Salary Range

The salary range for this position is approximately $90,000 - $115,000 annually, based on factors such as location, experience, and education.



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