Appeal Specialist II - RN (Remote)

Appeal Specialist II - RN reviews, analyzes, and resolves insurance denials to ensure accurate reimbursement and regulatory compliance. Responsibilities include logging and reviewing denials for trend reporting, providing feedback to facilities, and communicating payer updates to stakeholders. Collaborates with Denial Coordinators, Facility Denial Liaisons, and Managed Care Coordinators to ensure payer accountability, identifies education opportunities, prepares and distributes reports on appeal trends and activity, and recommends process improvements to enhance appeal efficiency and reduce recurring denials. Maintains knowledge of payer policies, billing and coding practices, and reimbursement regulations; uses practice management systems and maintains documentation in compliance with standards; supports initiatives to improve denial prevention and recovery processes; performs other duties as assigned; maintains regular attendance and complies with policies. Includes RN licensing requirement and healthcare revenue cycle expertise as core qualifications.