Registered Nurse (RN) Clinical Denials and Appeals

Inova 8095 - Fairfax East is looking for a dedicated Registered Nurse (RN) Clinical Denials and Appeals to join the team. This role will be Full-Time Remote, Monday-Friday (8-Hours per Day); Start Time to be between 7:30 AM - 9:00 AM Eastern Time (EDT/EST)

Inova is consistently ranked a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation.

Featured Benefits:

• Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program.

• Retirement: Inova matches the first 5% of eligible contributions - starting on your first day.

• Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans.

• Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost.

• Work/Life Balance: offering paid time off, paid parental leave, flexible work schedules, and remote career opportunities.

Registered Nurse (RN) Clinical Denials and Appeals Job Responsibilities:

• Reviews denied claims to identify the appropriateness of clinical care and determine if an appeal is warranted.
• Development and submission of timely appeals to payors.
• Collaborates with each facility and department (ex: UR, PFS, Coding, Billing, and HIM) to ensure accurate and complete documentation to support appeals.
• Provides education and training to staff and providers on appeal best practices and strategies.
• Monitors and reports on appeal outcomes, including success rates, trends, and barriers.
• Works with payors and external stakeholders to resolve complete appeal issues and improve communication and collaboration.
• Analyzes and identifies discrepancies in documentation and charges to provide educational support to applicable areas within Inova Health System.
• Demonstrates knowledge and understanding of patients' diagnoses, treatment plans and services, and associated costs, charges, and reimbursement.
• May perform additional duties as assigned.

Minimum Qualifications:

• Education: Bachelor's degree or equivalent of Associate's degree with RN license
• Experience: Three years of RN licensed experience in a clinical or hospital setting required
• Certification: Registered Nurse RN license or licensed to practice in the Commonwealth of Virginia as an RN

Preferred Qualifications:

• Experience: Clinical appeals writing, medical record/chart review, and utilization review; Strong clinical foundation with the ability to assess medical necessity and documentation support

• Other: Excellent verbal and written communication skills; Ability to work effectively in a collaborative, team-based environment

Remote Eligibility: This position is eligible for remote work for candidates residing in the following states - VA, MD, DC, DE, FL, GA, NC, OH, PA, SC, TN, TX, WV.