Clinical Denials Management Specialist

This position is listed on behalf of a partner company, which manages all applications and next steps. Our partner is looking for a Clinical Denials Management Specialist based in the United States.

In this fully remote role, you will leverage your clinical expertise and analytical skills to review, investigate, and appeal denied hospital insurance claims across a healthcare system. You will analyze clinical documentation, billing records, payer policies, and patient histories to develop compelling, evidence-based appeals that support appropriate reimbursement.

Working closely with nursing, utilization management, revenue integrity, and patient financial services teams, you will help resolve complex denials and identify opportunities to prevent future claim rejections. You will address a broad range of clinical and financial issues, including medical necessity, level-of-care determinations, clinical validation, and charge discrepancies.

Your work will directly contribute to revenue integrity, regulatory compliance, and the financial sustainability of healthcare services. This opportunity is ideal for an experienced registered nurse with strong clinical judgment, excellent writing skills, and a passion for improving healthcare reimbursement processes.