"Alerted.org

Job Summary

The Remote Denial Coordinator - Registered Nurse - PRN is responsible for reviewing, tracking, and resolving denied claims, ensuring that appropriate appeals are submitted, and working closely with payers, internal departments, and revenue cycle teams to identify and address denial trends. This role plays a critical part in the denials management process, supporting efforts to improve claims resolution, reduce future denials, and ensure compliance with payer guidelines.

Essential Functions

+ Monitors assigned denial pools and work queues in Artiva, HMS, Hyland, BARRT, and other host systems, ensuring timely follow-up on denials and appeals.

+ Conducts follow-up calls and payer portal research to track the status of submitted appeals and claim determinations, documenting all actions taken.

+ Communicates with key stakeholders across revenue cycle, billing, and clinical teams to resolve denial trends and improve claim submission accuracy.

+ Tracks and documents all denial and appeal activity, maintaining accurate records in system logs, account notes, and tracking reports.

+ Ensures compliance with all payer guidelines and regulatory requirements, keeping up to date with policy changes and appeal submission rules.

+ Manages BARRT requests (Outbound/Inbound) in a timely manner, ensuring that all required documentation and system updates are completed.

+ Identifies root causes of denials and collaborates with internal teams to implement process improvements that reduce future denials.

+ Prepares and submits appeal documentation, ensuring that all required medical records, forms, and supporting materials are included.

+ Performs other duties as assigned.

+ Complies with all policies and standards.

Qualifications

+ H.S. Diploma or GED required

+ Associate Degree or higher in Healthcare Administration, Business, Finance, or a related field preferred

+ Valid Registered Nurse (RN) license

+ 1-3 years of experience in denials management, insurance claims processing, or revenue cycle operations required

+ Experience in revenue cycle processes in a hospital or physician office required

+ Experience with payer appeals, claim resolution, and healthcare billing systems preferred

Knowledge, Skills and Abilities

+ Strong understanding of payer guidelines, claim adjudication processes, and denial management strategies.

+ Proficiency in Artiva, HMS, Hyland, BARRT, and other revenue cycle applications.

+ Excellent problem-solving skills, with the ability to analyze denial trends and recommend corrective actions.

+ Strong written and verbal communication skills, with the ability to engage effectively with payers, internal teams, and leadership.

+ Detail-oriented with strong organizational and documentation skills, ensuring compliance with payer appeal deadlines.

+ Ability to work independently and manage multiple priorities in a fast-paced environment.

Equal Employment Opportunity

This organization does not discriminate in any way to deprive any person of employment opportunities or otherwise adversely affect the status of any employee because of race, color, religion, sex, sexual orientation, genetic information, gender identity, national origin, age, disability, citizenship, veteran status, or military or uniformed services, in accordance with all applicable governmental laws and regulations. In addition, the facility complies with all applicable federal, state and local laws governing nondiscrimination in employment. This applies to all terms and conditions of employment including, but not limited to: hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. If you are an applicant with a mental or physical disability who needs a reasonable accommodation for any part of the application or hiring process, contact the director of Human Resources at the facility to which you are seeking employment; Simply go to http://www.chs.net/serving-communities/locations/ to obtain the main telephone number of the facility and ask for Human Resources.