Per Diem Clinical Appeals Nurse
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![]() United States, Minnesota, St. Paul | |
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We are seeking a qualified Clinical Appeals Nurse to join our revenue cycle in a per diem role at Regions Hospital. The Clinical Appeals Nurse will play a crucial role in ensuring that our patients receive the appropriate level of care by managing and appealing denied insurance claims. The ideal candidate will have a strong background in nursing, a thorough understanding of insurance policies and regulations, and excellent communication skills. The Clinical Appeals Nurse completes retrospective clinical appeals for full or partially denied claims for managed care, government, non-government, and commercial payors, writing comprehensive factual arguments to present to third party payors, medical review boards, or other responsible parties applying clinical criteria to establish medical necessity. The Clinical Appeals Nurse collaborates with physicians, case managers, and billing teams to gather necessary documentation for appeals, and drafts well-researched, evidence-based appeal letters to overturn claim denials from Medicare, Medicaid, and commercial insurers. Beyond addressing claims after they are denied, the Clinical Appeals Nurse will also work to prevent denials, utilizing clinical expertise to conduct trainings, provide relevant feedback, and complete root cause analysis for claims denials. This role is highly visible within the organization, and will forge partnerships within the broader HealthPartners organization, working closely with utilization management, coding, revenue cycle, care management, social work, and other areas within Regions and HealthPartners. The incumbent will have the opportunity to help shape the work and scope of this role, aligning revenue cycle best practices on an enterprise level. This position is eligible to work remotely following onsite training in Saint Paul, MN, with occasional onsite meetings depending on business needs. Employees must reside in Minnesota, Wisconsin, Iowa, North Dakota, or South Dakota, and have a reliable internet connection and a quiet place to work free from interruptions. Work Schedule:
Required Qualifications:
Preferred Qualifications:
Additional Information: This is a non-union 1.0 FTE (80 hours per pay period) day shift position. The full salary range for this position is $77,542.40-$120,182.40 annually, based on experience and internal equity. This position is non-exempt under the Fair Labor Standards Act, and not eligible for benefits. Regions is a qualified non-profit employer under the federal Public Service Loan Forgiveness program and proud to be a Yellow Ribbon Company. |