Clinical Denials Auditor

Huron

Clinical Denials Auditor managing denials and appeals processes for healthcare claims in hospitals. Reviewing clinical documentation, working with payors, and ensuring compliance.

Posted 6/23/2026full-timeRemote • Illinois • 🇺🇸 United StatesMid-LevelSenior💰 $34 - $43 per hourWebsite

About the role

Key responsibilities & impact

Review the claims denied and carry out the appeals process appropriately and in a timely manner.
Identify and work denials, responding to the denial reason and resubmitting any information needed to the payor.
Work denials and appeals timely, evaluating the denial reason including information from the payor and payor policies, reviewing the clinical documentation, assessing options and completing next steps.
Submit retro-authorizations in accordance with payor requirements in response to authorization denials.
Conduct medical necessity reviews, based on denial root cause, and prepare any required clinical documentation summaries to accompany appeals.
Write and submit written appeals which include compelling arguments based on clinical documentation, third-party payer medical policies, and contract language.
Document all actions taken and follow-up timely as needed related to resolving denials and appeals with third-party payers in a timely manner.
Track the status and progress of denials and appeals.
Identify denial patterns and escalate to management as appropriate with sufficient information for additional follow-up, and/or root cause resolution.

Requirements

What you’ll need

Clinical Appeals Experience: At least 1 year of clinical appeal writing experience.
Clinical Experience: Minimum of 3-5 years acute care clinical experience in a hospital setting (Med/Surg, or similar preferred); 2-3 years if ICU experience.
Education: Bachelor of Science in Nursing.
Licensure: Must be Registered Nurse with an active USRN license.
RCM Knowledge: Proficiency in using InterQual or MCG clinical guidelines.
Broad Knowledge of U.S. Government Programs and Insurance Regulations.
Software Knowledge: Proficiency with hospital-based electronic medical records (EMR) such as Epic, Cerner, or Meditech.

Benefits

Comp & perks

medical, dental and vision coverage
401(k) plan with a generous employer match
employee stock purchase plan
generous Paid Time Off policy
paid parental leave and adoption assistance
Wellness Program supports employee total well-being by providing free annual health screenings and coaching, bank at work, and on-site workshops
ongoing programs recognizing major events in the lives of our employees throughout the year

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

clinical appeal writingmedical necessity reviewsdenial managementclinical documentationretro-authorizationsthird-party payer policiesdenial pattern identificationroot cause analysisacute care clinical experienceICU experience

Soft Skills

timelinesscommunicationanalytical thinkingproblem-solvingattention to detailorganizational skillsescalationfollow-up

Certifications

Registered Nurseactive USRN license