POSITION SUMMARY

The Clinical Appeals Writer is responsible for drafting comprehensive, evidence-based appeal letters in response to clinical denials from payers. This role involves analyzing denial rationales, reviewing clinical documentation, applying clinical guidelines, and articulating compelling medical necessity arguments to support the healthcare provider’s position. The writer uses strong writing skills, clinical background, and a deep understanding of payer policies and regulatory requirements to overturn payor denials. Works closely revenue cycle and case management to manage to optimize claim payment. This is a hybrid position which can be worked on campus or remotely depending on the needs of the department. Remote Clinical Appeals Writer will be required to attend in person scheduled meetings and call in to weekly huddle.

EDUCATION

Bachelor’s degree in nursing and a valid RN license in the state of Georgia or compact license.

EXPERIENCE

• Five (5) years relevant hospital clinical nursing experience. An equivalent combination of education and experience will be considered.
• Recent experience as an inpatient utilization review nurse and/or appeals writer.

KNOWLEDGE, SKILLS, AND ABILITIES

• Excellent interpersonal communication, problem-solving, and conflict resolution skills.
• Computer skills in Epic, data base management, and spreadsheet preferred
• Knowledge in areas of: Medicare and Medicaid UM regulations, InterQual, Medicare Inpatient Only List, RAC, QIO, MAC, and Denial Management
• Strong clinical knowledge and ability to interpret medical records
• Exceptional writing and grammar skills with a focus on clarity and persuasiveness
• Ability to work independently and manage strict deadlines

Please refer the Job description for details