Registered Nurse (RN) Clinical Denials and Appeals

Inova 8095 - Fairfax East is looking for a dedicated Registered Nurse (RN) Clinical Denials and Appeals to join the team. This role will be Full-Time Remote, Monday-Friday (8-Hours per Day); Start Time to be between 7:30 AM – 9:00 AM Eastern Time (EDT/EST)

Inova is consistently ranked a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation.

Featured Benefits:

• Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program.

• Retirement: Inova matches the first 5% of eligible contributions – starting on your first day.

• Tuition and Student Loan Assistance: offeringup to $5,250 per year in education assistance and up to $10,000 for student loans.

• Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost.

• Work/Life Balance: offeringpaid time off, paid parental leave, flexible work schedules, and remote career opportunities .

Registered Nurse (RN) Clinical Denials and Appeals Job Responsibilities:

• Reviews denied claims to identify the appropriateness of clinical care and determine if an appeal is warranted.
• Development and submission of timely appeals to payors.
• Collaborates with each facility and department (ex: UR, PFS, Coding, Billing, and HIM) to ensure accurate and complete documentation to support appeals.
• Provides education and training to staff and providers on appeal best practices and strategies.
• Monitors and reports on appeal outcomes, including success rates, trends, and barriers.
• Works with payors and external stakeholders to resolve complete appeal issues and improve communication and collaboration.
• Analyzes and identifies discrepancies in documentation and charges to provide educational support to applicable areas within Inova Health System.
• Demonstrates knowledge and understanding of patients' diagnoses, treatment plans and services, and associated costs, charges, and reimbursement.
• May perform additional duties as assigned.

Minimum Qualifications:

• Education : Bachelor’s degree or equivalent of Associate’s degree with RN license
• Experience : Three years of RN licensed experience in a clinical or hospital setting required
• Certification : Registered Nurse RN license or licensed to practice in the Commonwealth of Virginia as an RN

Preferred Qualifications :

• Experience : Clinical appeals writing, medical record/chart review, and utilization review; Strong clinical foundation with the ability to assess medical necessity and documentation support

• Other : Excellent verbal and written communication skills; Ability to work effectively in a collaborative, team-based environment

Remote Eligibility : This position is eligible for remote work for candidates residing in the following states – VA, MD, DC, DE, FL, GA, NC, OH, PA, SC, TN, TX, WV.

We are Inova, Northern Virginia’s leading nonprofit healthcare provider. Every day, our 26,000+ team members provide world-class healthcare to the communities we serve. Our people are the reason we're a national leader in healthcare safety, quality and patient experience. And from best-in-class facilities to professional development opportunities, we support them at every step. At Inova, we're constantly striving to be ever better — to shape a more compassionate future for healthcare.

Inova Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, pregnancy (including childbirth, pregnancy-related conditions and lactation), race, religion, sex, sexual orientation, veteran status, genetic information, or any other characteristics protected by law.