RN Denial Management Specialist

Banner Health

RN Denial Management Specialist managing clinical audits and denial processes at Banner Health. Requires significant nursing experience and offers remote work in selected US states.

Posted 7/10/2026full-timeRemote • Alabama, Arizona, California, Colorado, Florida, Idaho, Iowa, Kansas, Kentucky, Minnesota, Mississippi, Missouri, Montana, Nevada, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia, Washington, Wisconsin, Wyoming • 🇺🇸 United StatesMid-LevelSenior💰 $37 - $62 per hourWebsite

About the role

Key responsibilities & impact

Provides clinical expertise and oversight in the determination of the clinical appeals and denial management process resulting in significant savings for the organization.
Evaluates and intervenes retrospectively for coverage issues, payor outliers, split billing, disallowed charges, incorrect DRG codes, denial and compliance issues.
Quantifies, analyzes, and monitors industry/Medicare trends in order to reduce denials and improve the financial outcomes for the organization.
Serves as a resource and provides leadership assistance to achieve optimal clinical, operational, financial, and satisfaction outcomes across the system as related to federal, state and commercial reimbursements.
Supports change and participates in the development, implementation and evaluation of the goals/objectives and process improvement activities across the organization as related to federal, state and commercial reimbursements.

Requirements

What you’ll need

Requires Registered Nurse (R.N.) licensure in the state of practice.
Requires experience in federal, state and commercial reimbursements and in reviewing clinical information typically acquired in three years auditing DRG coding and reimbursements.
Requires five or more years of clinical nursing and/or related experience.
Experience in evaluation techniques, teaching, hospital operations, reimbursement methods, medical staff relations, and the charging/billing process is required.
A working knowledge of utilization management and patient services is required.
A working knowledge of Medical and third party payor requirements and reimbursement methodologies is required.
Highly developed human relation and communication skills are required.
Must demonstrate critical thinking, problem-solving, effective communication, and time management skills.
Must demonstrate ability to work independently as well as effectively with team members.
Must be proficient in the use of office desktop software programs.

Benefits

Comp & perks

Health insurance
retirement plans
paid time off
flexible work arrangements
professional development

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Clinical Evaluation TechniquesDenial ManagementFinancial AnalysisProblem-SolvingTime Management

Soft Skills

Human Relation SkillsEffective CommunicationTeam CollaborationIndependent Work