State Licensed Clinical Denial Specialist
virtual vocationsDenver (CO)
State Licensed Clinical Denial Specialist
Posted today
virtual vocationsDenver (CO)
SENIORITY
Senior
About the role
Managing denial appeals and ensuring compliance, the full-time State Licensed Clinical Denial Specialist will conduct comprehensive reviews of patient medical records, validate clinical relevance, and negotiate with external auditors in a remote setting.
Key responsibilities:
Manage timely reviews and responses to hospital billing audits and appeals
Prepare and submit detailed clinical appeals while collaborating with clinical and coding teams
Evaluate patient medical records to ensure accuracy in documentation and billing
Required qualifications:
Associate degree in healthcare administration, Nursing, Health Information Management, or related field with five years of relevant experience, or a Bachelor's degree with three years of experience
Current state-issued Registered Nurse or Licensed Practical Nurse license, or relevant certification (RHIT, RHIA, CCDS, CDIP, CCS, CIC)
Experience in hospital billing, acute care settings, CDI, inpatient coding, or revenue cycle
Strong knowledge of CMS guidelines, coding rules, and clinical standards
Ability to work independently with minimal supervision while maintaining current clinical and coding knowledge
Before you apply
Applying takes about a minute. These four things decide how fast it moves after that.
Your profile is current
It's what we read first. Occupations, seniority and locations matter more than a long history.
Two examples you can talk through
Not a portfolio — just two pieces of work where you can explain the decisions and what you'd change.
A number in mind
What you're on now and what would make you move. We negotiate better when we know both.
Your notice period
Employers plan around it, and it's the question that stalls offers most often.
Once you apply, someone reads it and calls you before anything reaches the employer — usually within two working days.