About this role
The Clinical Denials/Appeals Nurse reviews and manages medical denials, coordinates appeals, and ensures documentation supports medical necessity. This role involves clinical review, collaboration with healthcare professionals, and communication with payers to resolve account issues.
Required Skills
- nursing
- Medical Records
- Medical Necessity
- Appeals
- Clinical Review
- Regulatory Policies
- Coding Guidelines
- Communication
- Documentation
- Healthcare Support
Qualifications
- Current Registered Nursing License
- Bachelor’s Degree
- 4+ years of clinical experience
About Guidehouse
guidehouse.comGuidehouse is a leading advisory firm that specializes in integrating commercial and public sector solutions to tackle complex challenges faced by clients. As a unique scaled advisory organization, it leverages insights from both government and commercial perspectives within its various industry segments. Guidehouse provides a range of technology and managed services, focusing on key sectors such as healthcare, financial services, defense, and infrastructure. The firm is recognized for its innovative approach to problem-solving, which combines strategic expertise with practical implementation.
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