Job Title: RN Clinical Appeals Specialist
Department: Revenue Cycle – Denial Management
Location: Onsite-Evanston, IL
Schedule: Monday – Friday | 7:00 AM – 4:00 PM (Latest start time: 8:00 AM)
Position Summary:
We are actively hiring Registered Nurse (RN) Clinical Appeals Specialists to join our client's growing Denial Management team. This role will have a strong focus on resolving complex clinical denials through evidence-based appeals. The Clinical Appeals Specialist will play a critical role in identifying denial trends, crafting compelling clinical arguments, and collaborating with cross-functional departments to optimize reimbursement outcomes.
Key Responsibilities:
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Review, assess, and process 25+ clinical appeals per day for medical necessity, level of care, and authorization-related denials.
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Draft well-supported, clinically sound appeal letters using medical documentation and payer guidelines.
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Collaborate closely with Utilization Review (UR), Nursing, and Coding teams to gather essential documentation and coordinate responses.
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Participate in peer-to-peer reviews with payers to support overturn of denied claims.
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Analyze denial patterns and recommend process improvements to minimize future denials.
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Ensure compliance with all payer timelines, regulatory standards, and internal protocols.
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Maintain thorough documentation of all appeals in Epic and other relevant systems.
Required Qualifications:
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Active Registered Nurse (RN) license in the state of [Insert State].
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Minimum 3 years of experience working with clinical denials and appeals in a hospital or payer setting.
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Strong understanding of payer policies for Medicare, Medicaid, and commercial insurers.
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Exceptional written communication skills and the ability to articulate clinical reasoning in written appeals.
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Familiarity with Epic and denial management workflows.
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Strong organizational skills and ability to prioritize high volumes of appeals under tight deadlines.
Preferred Qualifications:
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Experience participating in peer-to-peer or physician-level appeal processes.
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Knowledge of utilization review and case management principles.
Ariel Greene
Project Manager
LaSalle Network
LaSalle Network is an Equal Opportunity Employer m/f/d/v.
LaSalle Network is the leading provider of direct hire and temporary staffing services. For over two decades, LaSalle has helped organizations hire faster and connect top talent with opportunities, from entry-level positions to the C-suite. With units specializing in Accounting and Finance, Administrative, Marketing, Technology, Supply chain, Healthcare Revenue Cycle, Call Center, Human Resources and Executive Search. LaSalle offers staffing and recruiting solutions to companies of all sizes and across all industries.
LaSalle Network is the premier staffing and recruiting firm, earning over 100 culture, revenue and industry-based awards from major publications and having its company experts regularly contribute insights on retention strategies, hiring trends and hiring challenges, and more to national news outlets. LaSalle Network offers temporary Field Employees benefit plans including medical, dental and vision coverage. Family Medical Leave, Worker's compensation, Paid Leave and Sick Leave are also provided. View a full list of our benefits here: View a full list of our benefits here.
