Clinical Denial Specialist, RN
Employment Type: Full – Time
Job Category: Care Coordination
Shift: Day
Facility: Interchange Building
Location: Atlanta, GA
Req ID: 2025-82872
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Our team members report that our state-of-the-art environment, work/life balance, reputation as a leader both locally and nationally, continuing education offerings, growth opportunities, and pay/benefits/pension plan are why they chose — and chose to stay with — Northside Hospital.
Contact us today to learn more about careers at Northside. Side by side, there’s nothing we can’t achieve!
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Job Details
Position Description
Processes, tracks and appeals clinical denials. Supports and facilitates the design, development and implementation of Utilization Management data collection methodologies and studies in the respective functional areas. Displays and analyzes data to identify trends. Works collaboratively to develop plan of action.
Position Requirements
REQUIRED
Case Management:
- Graduate of an accredited school of nursing, with strong clinical case management experience
- Three (3) years experience in Utilization Management/Case Management or related field, with specific experience in the following areas: the application of industry prevalent guideline criteria; knowledge of coding, billing, audit and reimbursement payer methodologies and guidelines. Experience in the collection, interpretation, and presentation of data to medical staff members; and, interaction with managed care companies, including appealing denials.
General:
- Excellent written and verbal communication skills.
- Ability to communicate effectively with business office, physicians, clinical care team and case management team.
- Ability to type accurately at an approximate rate of 30 words per minute.
Awards & Recognitions
Excellence is what we do. We are committed to providing safe, high-quality, compassionate care for our patients. While also creating a culture where people feel appreciated, well cared for and supported in their work.
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