Clinical Denials Specialist

Since 1984, UASI has been one of the largest independent healthcare revenue cycle consulting firms in the United States. We are a nationally recognized leader in Health Information Management, delivering solutions that support optimization and strategic alignment across the mid-revenue cycle. UASI partners with healthcare organizations to strengthen financial, clinical, and operational performance through flexible problem solving and proven expertise. Our services are designed to help clients achieve accuracy, compliance, and efficiency while aligning documentation, coding, and revenue integrity efforts with organizational goals. UASI is a trusted partner to more than 1,100 hospital facilities and physician groups nationwide, supported by 540 nationally credentialed experts, including CCS, CCDS, CDIP, RHIA, and RN professionals. Our teams consistently deliver results, achieving 96%+ coding accuracy based on third-party audits, and earning recognition as Best in KLAS. We offer comprehensive services and employment opportunities across Remote Coding, Coding Compliance Review, Education and Training, Clinical Documentation Improvement, HIM and Coding Interim Management, and Revenue Integrity. Our work supports mid-revenue cycle optimization by identifying opportunities, reducing risk, and delivering actionable insight that drives sustainable performance. Our client base includes top-ranked hospitals recognized for academic excellence, research, quality, and patient care. Through this diverse client portfolio, remote employment opportunities, and multiple service lines, we engineer individualized career paths and promote balance for every employee. As regulatory complexity and coding demands continue to increase, UASI remains grounded in the core values on which the company was founded, providing strategic, practical solutions that help healthcare organizations produce low-cost, high-quality records with confidence.

United Audit Systems, Inc. (UASI), a rapidly growing healthcare consulting firm seeks to expand its professional team of employees by adding experienced Clinical Appeals Review Nurse to our team. The Clinical Appeals Review Nurse is responsible for completing clinical denial reviews to determine appropriate appeal of patient accounts. The ideal candidate will have a combination of clinical experience in a hospital acute care setting and experience providing reviews of the hospital billing and charging policies.

Completes clinical review of pre- and post-claim denials DRG Denials Perform a variety of audit services including charge audit, compliance audit, medical necessity, denials and other requests as needed. Audits may be performed on a concurrent or retrospective basis Review and analyze the client inpatient and/or outpatient itemized billing statement and the patient medical record and related documentation to identify items that were not billed correctly. Document findings on appropriate form and submit findings to client management staff daily so new billing forms can be generated in hospitals billing systems. Adhere to the National Health Care Billing Audit Guidelines, UASI Code of Conduct and Compliance Program, and the client third party audit policy while performing all duties. Attend meetings with members of client-hospital finance, medical records, and ancillary departments. Educate Client-Hospital personnel on validation and documentation of charges if requested by client contract relationship. Navigate hospitals medical record system and understand where to locate the financial information in relation to the patient payor billing information