AdventHealth Careers for Veterans

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AdventHealth Registered Nurse Clinical Denials Specialist in Miami, Florida


Registered Nurse Clinical Denials Specialist

AdventHealth Corporate

Location Address: 2600 Lucien Way, Maitland, FL 32751

Top Reasons to Work at AdventHealth Corporate

  • Great benefits

  • Immediate Health Insurance Coverage

  • Career growth and advancement potential

  • Faith-based environment

Work Hours/Shift:

  • Full-Time, Monday – Friday-Remote work at home opportunity available

Do you have a passion for;

  • Working retrospective clinical denials, both from the Inpatient and Outpatient perspective

  • Conducting patient account history research, including navigating patient encounters and charts, reviewing the payer websites, researching charge and payment histories to determine appropriate course of appeal

  • Collaborating with pre-access, patient financial services, revenue integrity, utilization management and clinical department staff to obtain further patient information to be used in the appeals process

  • Discussing or educating others on proper documentation, payer processes, and policies, and clinical denial trends

  • Defending and appealing denied claims via both written and verbal communication in clear and concise arguments/rationale in clinical terms/language.

  • Utilizing multiple IT solutions to ascertain complete clinical and financial information to formulate comprehensive appeals

If yes, then this is the position for you! We have a strong Centralized Denial Management Team, serving the AdventHealth system across multiple states and are seeking RNs to add to our Clinical Team.


What You Will Need:

  • RN with Bachelor’s Degree in Nursing, Management or related healthcare field.

  • Minimum of three (3) years’ experience as Registered Nurse (RN) in an acute clinical setting

  • Current and valid RN license

  • Knowledge of InterQual and/or MCG as well as CMS LCD/NCD documentation

  • Experience in Denials Management, Utilization Management, and/or Appeal research and writing.

Job Summary:

Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all. This position is responsible for investigating and resolving clinical related denials from payers on Inpatient and Outpatient post-remit claims. The position will require experience in case management and/or utilization management, with a focus on researching and appealing clinical denials. The Clinical Denial Specialist will serve as a resource for clinical questions and guidance on working clinical denials. This position will utilize the appropriate tools to communicate with other departments regarding any necessary updates to ensure accurate and timely claim adjudication. The Clinical Denial Specialist will adhere to the AHS Compliance Plan and to all rules and regulations of all applicable local, state and federal agencies and accrediting bodies.

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.