Registered Nurse (RN) Clinical Denials and Appeals
InovaInova 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.