Clinical Appeals Nurse

R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems, and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration.

As our Clinical Appeals Nurse, you will help our hospital clients by serving as an expert on appeals and denials management where claims were denied by either governmental contractors or commercial payers. Every day you will thoroughly review patient clinical and hospital course documentation, as well as payer policy and denial information. Once reviewed, then you will prepare an appropriate written document and represent client hospitals during hearings if needed.

To thrive in this role, you must have experience in a clinical inpatient environment working with a wide range of patient populations, and the ability to use sound judgment in reviewing clinical documentation supporting patient care as well as conceptual knowledge of the denials landscape. P...