What are the responsibilities and job description for the Clinical Appeals/Denials Specialist/RN position at ERISA Recovery?
Ready to Move Beyond Bedside Nursing? Join Our Clinical Appeals Team!
ERISA Recovery is seeking an experienced Registered Nurse (RN) with a strong background in utilization management, clinical review, and denial appeals to join our growing team in Plano.
This is an ideal opportunity for RNs to be ready to move beyond bedside care and apply their clinical judgment in a strategic, analytical role that directly impacts healthcare reimbursement.
What You’ll Do
- Analyze denied claims and clinical documentation to identify appeal opportunities
- Perform medical necessity reviews (inpatient & outpatient cases)
- Develop and submit high-quality clinical appeals and support peer-to-peer reviews
- Apply industry-standard tools: InterQual, MCG (Milliman), McKesson
- Collaborate with physicians, case managers, and utilization review teams
- Resolve issues related to authorizations, pre-certifications, and continued stay reviews
- Track denial trends and contribute to process improvement initiatives
Your Experience
- Active RN license (required)
- 3–5 years of experience in one or more:
- Utilization Management (UM)
- Inpatient Case Management
- ER Case Management
- Strong experience with:
- Medical necessity criteria tools (InterQual, MCG, McKesson)
- Appeals and denial overturns
- Payer guidelines and reimbursement models
- Excellent clinical judgment, writing, and analytical skills
Nice to Have
- CCM or Case Management certification
- Experience with denial analytics/reporting
- Knowledge of Medicare Advantage & Medicaid Managed Car
Compensation & Benefits
- Competitive salary (commensurate with experience)
- 401(k) company match
- Medical, dental, vision insurance
- Paid time off
- Paid lunches
- No weekends / No holidays
- Monday-Friday 8-hour per day schedule
- On site only
- Must be able to commute or relocate prior to start
ERISA Recovery is a fast-growing company based in Plano, TX, specializing in the recovery of aged and complex claims using the Federal ERISA appeals process. Our collaborative and innovative team offers an extraordinary opportunity for career growth in the ever-evolving revenue cycle industry.
ERISA Recovery is an Equal Opportunity Employer
Salary : $65,000 - $80,000