Clinical Appeals Coordinator - Part Time

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Important Applications Instructions

Please complete this application in entirety by providing all of your work experience, education and certifications/ license. You will be unable to edit/add/change your application once it is submitted.

Job Requisition ID

R00055029

Job Category

Nursing

Organization

Rev Cycle - Patient Access PAU

Location/s

Central Billing Office-Clinton

Job Title

Clinical Appeals Coordinator - Part Time

Job Summary

Coordinates and supports the billing process, including denial and appeal reviews. Evaluates and monitors patient care payment denials and related claims while supporting the development of strategies to minimize financial risk through effective appeals management. Conducts research, collaborates with departments to verify denials, perform clinical reviews, and prepares reports to support quality improvement initiatives and prevent future denials. Education & Experience

Education and Experience Required

Two (2) years of nursing experience.

Certifications, Licenses, or Registration required

Valid RN license.

Preferred Qualifications

Utilization review and case management experience. Knowledge, Skills & Abilities

Knowledge, Skills, and Abilities

Knowledge and understanding of clinical organization structure, workflow, and operating procedures. Skill in the use of personal computers and related software applications. Ability to manage multiple priorities under time constraints; ability to analyze and solve problems.

Understanding cost and quality issues. Verbal and written communication skills. Interpersonal skills to interact with a wide range of constituencies.

Decision-making skills. Responsibilities Reviews patient medical records and collects data to support billing and appeals management, analysis, and monitoring activities. Communicates with insurers to determine the appropriateness of payments or denials.

Collects, reviews, and submits timely appeals for medical necessity and authorization of denials. Conducts clinical research and analysis to identify issues and develop strategies that improve the payment and appeals process. Assists with chart audits by reviewing and comparing medical records against itemized patient bills to ensure accuracy and maintain revenue integrity.

Analyzes denial and payment data to identify trends and patterns, supporting system-wide performance improvement and management education. Supports quality improvement initiatives by reviewing clinical practices for consistency, adherence to policy, and appropriate levels of care across settings; prepares reports and communicates findings to clinical and non-clinical staff. Communicates and negotiates with external stakeholders, including insurance payers, regarding appeal outcomes.

Maintains knowledge of current regulatory and accreditation standards related to denial and appeals management to support organizational compliance. The duties listed are general in nature and are examples of the duties and responsibilities performed and are not meant to be construed as exclusive or all-inclusive. Management retains the right to add or change duties at any time.

Physical and Environmental Demands Requires occasional exposure to unpleasant or disagreeable physical environment such as high noise level and exposure to heat and cold, occasional exposure to bio-hazardous conditions such as risk of radiation exposure, blood borne pathogens, fumes or airborne particles, and/or toxic or caustic chemicals which mandate attention to safety considerations, occasional working hours significantly beyond regularly scheduled hours, occasional travelling to offsite locations, occasional work produced subject to precise measures of quantity and quality, occasional bending, occasional lifting and carrying up to 25 pounds, occasional crouching/stooping, occasional kneeling, occasional pushing/pulling, frequent reaching, frequent sitting, frequent standing, occasional twisting, and frequent walking. (occasional-up to 20%, frequent-from 21% to 50%, constant-51% or more)

Time Type

Part time

FLSA Designation/Job Exempt

No

Pay Class

Hourly

FTE %

100

Work Shift

Benefits Eligibility

Grant Funded

Job Posting Date

10/23/2026

Job Closing Date (open until filled if no date specified)

10/27/2026