Clinical Supervisor, Denial Management RN

This is a fully remote position, open to applicants in Florida.

📋 Description

• Oversee denial management and clinical appeal services on behalf of clients.

• Provide leadership and supervise the daily operations of an Appeals team made up of Appeal Coordinators and support personnel.

• Manage relationships, evaluate staff performance, and ensure quality assurance.

• Offer continual support, mentorship, guidance, and development for team members.

• Organize and manage the processes and workflows of the Appeals team.

• Ensure team members comprehend and carry out their responsibilities and assigned tasks.

• Engage with both internal and external clients, including payers.

• Oversee staff performance and revenue cycle management through the use of KPIs.

• Conduct root cause analysis for denials.

• Collaborate across departments.

• Develop workflows and manage escalations effectively.

• Prepare and present reports on operational progress.

• Cultivate relationships with the team and external stakeholders.

• Coordinate training sessions.

• Prepare necessary documentation.

• Ensure compliance oversight.

• Review and audit documentation thoroughly.

⛳️ Requirements

• A valid RN license in good standing is mandatory.

• RN qualification is required.

• Prior experience in directly managing a team is preferred.

• Exceptional communication and interpersonal abilities, particularly to connect with remote team members and internal/external clients.

• Excellent organizational and leadership capabilities.

• Ability to delegate tasks effectively and provide leadership and training to key personnel.

• Strong critical thinking skills.

• Capacity to offer strategic insights for process improvement or standardization.

• Commitment to confidentiality.

• Strict compliance with HIPAA/HITECH regulations.

• RN degree and license preferred/required.

• Experience with Payor and Provider Appeals is advantageous.

• Familiarity with CPT and ICD 10 guidelines is necessary.

• Knowledge of Medicare, Medicaid, Commercial, and Managed Care is important.

• Experience with CDI, CCS, and DRG appeals is preferred and a plus.

• 3 to 5 years of experience or prior knowledge in healthcare, insurance, specifically in denials management, claims, and appeal writing.

• Experience with the Epic system.

• Proficiency in relevant software applications such as MS Office and Teams.

• Good keyboarding skills.

• Ability to collaborate effectively with staff and other departments within the healthcare system.

• Must be available to work daytime business hours in CST/EST.

• Ability to perform computer-based tasks for 6–8 hours daily.

• Capability to lift and move materials weighing up to 20 lbs. infrequently.

🏝️ Benefits

• Opportunities for professional development and personal growth.

• Remote work from home options available.

• Daytime business hours in CST/EST.

• Reasonable accommodations for individuals with disabilities.