Clinical Appeals Specialist

3 days ago


Raleigh, North Carolina, United States Piper Companies Full time

Piper Companies is seeking a highly skilled Clinical Appeals Specialist to join their team and work remotely for a leading health insurance organization. As a Clinical Appeals Specialist, you will play a critical role in analyzing, reviewing, and submitting complex appeals to ensure member satisfaction.

Key Responsibilities:

• Assess and review non-routine appeals and grievances to ensure timely and accurate resolution

• Collaborate with non-clinical staff to provide clinical expertise and support

• Coordinate appeals process activities to ensure compliance and efficiency

• Perform accurate and complete work in a timely and efficient manner

• Report to the Manager, Nurse Lead/Team Leader, and Medical Lead

Requirements:

• 3+ years of inpatient care experience in ER, med/surg, critical care, ICU, or step-down units

• Experience with EMR/EHR Systems

• RN or LPN licensure in North Carolina

• Associate degree or higher required

Preferred Locations:

NC, AL, AZ, AR, CO, FL, GA, ID, IN, IA, KS, KY, LA, MD, MI, MS, MO, OH, OK, PA, SC, SD, TN, TX, UT, VA, WI, WY

Compensation:

• Salary Range: $38-41/hr based on relative experience

• Comprehensive Benefits: Medical, Dental, Vision, 401k

Keywords: Clinical Appeals Specialist, health insurance, RN, LPN, NC, EMR, NCDOI, NCQA, pharmaceutical companies, healthcare, complex appeals, claims, analysis, research



  • Raleigh, North Carolina, United States Clinical Management Consultants Full time

    Cardiovascular Specialist OpportunityWe are seeking a skilled Cardiovascular Specialist to join our team at Clinical Management Consultants.This role involves assisting physicians with a variety of invasive cardiac and vascular procedures and participating in a call back rotation.The successful candidate will work alongside surgeons in the Hybrid OR to...


  • Raleigh, North Carolina, United States Clinical Management Consultants Full time

    Cardiovascular Specialist Job DescriptionWe are seeking a skilled Cardiovascular Specialist to join our team at Clinical Management Consultants.This role involves assisting physicians with a variety of invasive cardiac and vascular procedures in our state-of-the-art Hybrid OR.The successful candidate will work closely with surgeons to diagnose and treat...


  • Raleigh, North Carolina, United States Raleigh Orthopaedic Clinic Full time

    Job SummaryThe Medical Claims Specialist is responsible for daily follow-up of Accounts Receivable, denials and appeals. Works with patients and insurance carriers to resolve billing and claims issues per individual carrier guidelines.Key Responsibilities:* Daily follow-up of Accounts Receivable, denials and appeals* Works with patients and insurance...


  • Raleigh, North Carolina, United States ICON Clinical Research Full time

    Job Title: Clinical Research NurseWe are seeking a skilled Clinical Research Nurse to join our team at ICON Clinical Research. As a CRC Nurse, you will play a vital role in designing and analyzing clinical trials, interpreting complex medical data, and contributing to the advancement of innovative treatments and therapies.Key Responsibilities:Coordinate and...


  • Raleigh, North Carolina, United States Piper Companies Full time

    Piper Companies is seeking a skilled Coding and Compliance Specialist to join their team in Raleigh, North Carolina. As a key member of the Coding team, this individual will be responsible for identifying coding-related issues from review of denials and appeals.Key Responsibilities:Review denials and appeals to identify coding-related issuesMonitor work...


  • Raleigh, North Carolina, United States Piper Companies Full time

    Piper Companies is seeking a skilled Coding and Compliance Specialist to join their team in Raleigh, North Carolina. This role will be responsible for reviewing denials and appeals, identifying coding-related issues, and reporting fluctuations in inpatient and outpatient accounts.Key Responsibilities:Review and analyze denials and appeals to identify...

  • Clinical Specialist

    4 days ago


    Raleigh, North Carolina, United States VitalConnect Full time

    Job Title: Clinical SpecialistVitalConnect is seeking a highly skilled Clinical Specialist to join our team. As a Clinical Specialist, you will be responsible for providing clinical customer support to effectively implement our solutions into customer sites.Key Responsibilities:Implement the clinical training program to various customer sites throughout the...

  • Clinical Specialist

    4 days ago


    Raleigh, North Carolina, United States VitalConnect Full time

    Job Title: Clinical SpecialistVitalConnect is seeking a highly skilled Clinical Specialist to join our team. As a Clinical Specialist, you will be responsible for providing clinical customer support to effectively implement our solutions into customer sites.Key Responsibilities:Implement the clinical training program to various customer sites throughout the...

  • Safety Specialist

    3 weeks ago


    Raleigh, North Carolina, United States Catalyst Clinical Research LLC Full time

    Job Title: Safety SpecialistCatalyst Clinical Research LLC is seeking a highly skilled Safety Specialist to join our Clinical Development Operations team. As a key member of our team, you will be responsible for coordinating and managing contracted safety responsibilities for one or more programs, including staffing, training, and procedural compliance.Key...


  • Raleigh, North Carolina, United States WakeMed Full time

    About WakeMedWakeMed is a leading healthcare provider dedicated to delivering exceptional patient care and advancing the practice of nursing.Position InformationThe Clinical Nurse Specialist/PI Coordinator is a key role in our organization, responsible for leading clinical practice and innovation in a specific area of nursing. This position requires a strong...

  • Clinical Specialist

    4 weeks ago


    Raleigh, North Carolina, United States Calyxo Full time

    Job Title: Clinical SpecialistCalyxo, Inc. is a medical device company dedicated to improving kidney stone treatment. We are seeking a highly skilled Clinical Specialist to join our team.Job SummaryThe Clinical Specialist will provide clinical case coverage, train surgical teams, and maintain current knowledge of perioperative surgical technology practice...


  • Raleigh, North Carolina, United States WakeMed Full time

    About WakeMedWakeMed is a leading healthcare provider dedicated to delivering exceptional patient care and advancing the practice of nursing.Position InformationThe Clinical Nurse Specialist/PI Coordinator is a key role in our organization, responsible for leading clinical practice and innovation in a specific area of nursing. This position requires a strong...


  • Raleigh, North Carolina, United States Best Buy Full time

    Job SummaryWe're seeking a skilled Visual Merchandising Specialist to join our team at Best Buy. As a key member of our retail team, you'll be responsible for creating visually appealing store displays and ensuring a seamless customer experience.Key ResponsibilitiesDesign and implement visually appealing store displays that showcase our products in the best...


  • Raleigh, North Carolina, United States VitalConnect Full time

    Job Title: Clinical SpecialistJoin VitalConnect as a Clinical Specialist and play a vital role in implementing our solutions at customer sites. As a Clinical Specialist, you will provide clinical customer support to effectively implement VitalConnect's solutions into customer sites.Key Responsibilities:Implement the clinical training program to various...


  • Raleigh, North Carolina, United States WakeMed Full time

    About WakeMedWakeMed is a leading healthcare provider dedicated to delivering exceptional patient care and advancing the practice of nursing.Job SummaryThe Clinical Nurse Specialist/PI Coordinator is a key member of our nursing team, responsible for leading clinical practice and improving patient outcomes.Key ResponsibilitiesDevelop and implement...


  • Raleigh, North Carolina, United States WakeMed Full time

    About WakeMedWakeMed is a leading healthcare provider dedicated to delivering exceptional patient care and advancing the practice of nursing.Job SummaryThe Clinical Nurse Specialist/PI Coordinator is a key role in our organization, responsible for leading clinical practice and innovation in a specific area of nursing. This position requires a strong clinical...


  • Raleigh, North Carolina, United States WakeMed Full time

    About WakeMed:Serving the community since 1961, WakeMed Health & Hospitals is a leading provider of health services in Wake County. With a mission to improve the health and well-being of our community, we are committed to delivering outstanding and compassionate care. For more information, visit our website.Position Information:The Clinical Support...


  • Raleigh, North Carolina, United States WakeMed Full time

    About WakeMedWakeMed is a leading healthcare provider dedicated to delivering exceptional patient care and advancing the practice of nursing.Job SummaryThe Clinical Nurse Specialist/PI Coordinator is a key role in our organization, responsible for leading clinical practice and innovation in a specific area of nursing. This position requires a strong clinical...


  • Raleigh, North Carolina, United States WakeMed Full time

    About WakeMed:WakeMed Health & Hospitals is a leading provider of health services in Wake County, serving the community since 1961. Our mission is to improve the health and well-being of our community by providing outstanding and compassionate care.Position Overview:The Emergency Department Clinical Nurse Specialist is a clinical leader responsible for a...


  • Raleigh, North Carolina, United States WakeMed Full time

    Job DescriptionAbout WakeMed:WakeMed is a leading healthcare provider dedicated to delivering exceptional patient care and advancing the practice of nursing.Job Summary:The Clinical Nurse Specialist/PI Coordinator is a key member of our nursing team, responsible for leading clinical practice and improving patient outcomes.Key Responsibilities:Develop and...