• Job Description

  Req#: 62356
  Overview
  
  The Clinical Denial Management Nurse is responsible for completing, tracking, and reporting clinical denials at an enterprise level across all UF hospitals. Reporting to the Enterprise Denial Nurse Manager, this role supports Revenue Cycle functions including clinical departments, finance, accounting, compliance, patient financial services, revenue integrity, managed care, utilization review, and patient access.
  
  The Clinical Denial Management Nurse serves as a clinical expert in denial management, ensuring all denied claims are reviewed from a clinical perspective and appropriately appealed to secure maximum reimbursement and minimize organizational write-offs.
  
  Responsibilities
  
  Necessary Skills
  
  • Knowledge of hospital billing and reimbursement, including Medicare/Medicaid denials, appeals, contracts, and healthcare regulations
  • Ability to read and interpret Explanation of Benefits (EOBs)
  • Strong critical thinking, analytical, and problem-solving skills
  • High attention to detail with ability to work independently and accurately
  • Strong organizational and time-management skills
  • Excellent written and verbal communication skills
  • Proficiency in Microsoft Office (Outlook, Word, Excel)
  • Knowledge of HIPAA guidelines
  • Comfort working with computer systems and healthcare technology
  
  Qualifications
  
  Qualifications
  
  Education:
  
  • High School Diploma or GED required
  • BSN preferred
  
  Licensure:
  
  • Active RN or LPN license in the State of Florida required
  • CPC, COC, RHIT, RHIA, or CCS preferred
  
  Experience:
  
  • RN: 2-3 years clinical experience required OR
  • LPN: 3-5 years clinical experience required
  • Coding, medical record review, auditing, or insurance experience preferred

• About the company

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