Remote Clinical Appeals Nurse PRN

TRC Talent Solutions is a full-service talent solutions provider with over 40 years of industry experience. Established in 1980, TRC is one of the largest privately held staffing firms in the country. Like his father, President and CEO Brian Robinson, remains focused on the idea that the marketplace continues to need a staffing agency built on principles and values, and is committed to providing the highest level of service in the industry.

100% Remote! This is an hourly PRN (as needed) position, and the hours will vary based on the needs of the department. Bachelor's degree in Nursing, Health Administration, or related field is required. Our team assists healthcare providers with the remediation of 3rd party accounts receivable, call center support and a variety of revenue cycle outsource capabilities. In this role, you will play a vital role in ensuring the accurate and timely review of insurance denials and appeals, advocating for our patients and healthcare providers. You will collaborate with healthcare providers and insurance companies to facilitate the clinical appeal process, utilizing your clinical expertise to support the necessity of medical services.

Conduct thorough and accurate reviews of insurance denials and appeals Advocate for patients and healthcare providers by communicating and negotiating with insurance companies Utilize clinical knowledge and expertise to identify and resolve issues with clinical denials and appeals Collaborate with other members of your team to gather necessary information and documentation for appeal Ensure timely and accurate submission of clinical appeals Maintain detailed and organized documentation of denials and appeals processes Stay up-to-date on insurance policies and regulations to ensure compliance in appeals Communicate effectively with patients, healthcare providers, and insurance companies regarding denials and appeals Monitor and track the success rate of appeals and identify areas for improvement Adhere to ethical and legal standards in all aspects of the job Maintain confidentiality of patient information and adhere to HIPAA regulations Participate in meetings and committees related to denials and appeals Continuously seek opportunities to improve processes and efficiency Ensure timely and accurate reporting of denials and appeals to management