Clinical Appeals Nurse

The Clinical Appeals Writer is responsible for preparing, reviewing, and submitting well-supported clinical appeals to healthcare insurance providers to challenge denied or underpaid medical claims. The role involves reviewing medical records, clinical documentation, and payer denial reasons to develop clear, accurate, and evidence-based appeal letters that support medical necessity, appropriate coding, and reimbursement decisions.

The ideal candidate is a Registered Nurse with at least one year of hands-on experience in clinical appeals writing, preferably within a healthcare BPO or Revenue Cycle Management environment.

Key Responsibilities

• Review medical records, clinical documentation, and insurance denial letters to identify reasons for claim denials.
• Develop and write comprehensive, evidence-based clinical appeal letters to support the medical necessity and appropriateness of services rendered.
• Analyze clinical information against