Clinical Denials Specialist | USRN | WFH

We are seeking a highly skilled Clinical Denials Specialist (USRN) to support denial management and utilization review functions for US healthcare clients.

The ideal candidate will possess strong clinical judgment, in-depth knowledge of payer guidelines, and hands‑on experience in medical necessity reviews and appeal writing. This role plays a critical part in improving reimbursement outcomes and reducing payer denials.

Key Responsibilities

• Perform advanced‑level clinical denial and utilization management activities in accordance with payer policies and regulatory requirements.
• Conduct comprehensive reviews of clinical documentation to determine medical necessity and appropriateness of care.
• Manage medical denials , including identification, analysis, resolution, and appeal submission.
• Handle audit, compliance, and other administrative responsibilities as assigned.
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