Clinical Appeals RN

We are seeking a highly skilled Clinical Appeals RN to join our client's healthcare team. In this role, you will be responsible for managing and resolving medical claims denials, ensuring accuracy in coding and providing clinical expertise in the appeals process. You will collaborate with insurance providers, billing departments and clinical teams to reduce denials and improve reimbursement outcomes. This role is located fully onsite in Evanston, IL.

Clinical Appeals RN Responsibilities:

• Review and analyze denied claims to determine root cause
• Collaborate with coding and billing teams to ensure accurate documentation
• Submit timely appeals to insurance carriers
• Provide clinical rationale and documentation for denied claims
• Work with payers and providers to resolve claims discrepancies
• Monitor and track denial trends to identify areas for improvement
• Maintain up-to-date knowledge of payer policies and guidelines

• Active RN license in the state of Illinois
• 3+ years of experience in denials management, appeals or utilization review
• Strong knowledge of medical billing, coding (ICD-10, CPT) and payer requirements
• Excellent analytical and problem-solving skills
• Familiarity with Electronic Medical Records (EMR) systems
• Exceptional communication skills, both written and verbal

• Experience in a hospital or specialty clinic setting preferred
• Knowledge of healthcare regulations, including HIPAA and Medicare/Medicaid guidelines preferred

If you are a dedicated and experienced RN with a passion for improving patient outcomes through effective denial management, we’d love to hear from you. Please submit your resume for consideration.

Thank you,

Ariel Greene
Project Manager
LaSalle Network