(Remote – U.S.)
🧾 About the Role
WVU Medicine is hiring a Clinical Denial Coordinator to lead and coordinate the appeals process for denied medical claims. This full-time, remote position blends clinical knowledge, writing skill, and analytical insight to recover revenue and identify systemic issues. You’ll work closely with clinical and administrative teams to investigate denials, craft appeals, and guide process improvements across the revenue cycle.
✅ Position Highlights
• Schedule: 40 hours/week
• Employment Type: Full-Time
• Remote – U.S. based
• Department: Clinical Denial Management
• Exempt role (salaried)
• Req ID: JR25-10925
• Posted: 9 days ago
📋 What You’ll Own
• Write clinical appeals for denials from RAC, Medicaid RAC, payers, and government agencies
• Review patient medical records to ensure proper documentation aligns with billed services
• Identify over- or under-billed items and submit corrections
• Negotiate with auditors to resolve billing disputes using supporting clinical documentation
• Coordinate the collection and database entry of denial correspondence
• Partner with Case Management, Access, and providers to facilitate appeals
• Identify denial trends and lead education sessions for staff and leadership
• Analyze root causes and propose solutions to reduce future denials
• Distribute denial reports and assist with organizational follow-ups
🎯 Must-Have Traits
• Active RN license in applicable state or multi-state license via eNLC (required)
• Minimum 3 years of healthcare clinical experience
• Strong clinical judgment and familiarity with payer policies and medical necessity standards
• Strong writing and negotiation skills, especially for appeals
• Detail-oriented with the ability to work independently
• Knowledge of CPT codes, LCD/NCD policies, and surgical/observation medical necessity
💻 Remote Requirements
• Reliable internet connection
• Secure, distraction-free home workspace
• Must be comfortable handling PHI in compliance with HIPAA
💡 Why It’s a Win for Remote RNs with Auditing Experience
• High-impact role that directly supports hospital revenue and patient access
• Use your clinical expertise outside the traditional care setting
• Work from home while influencing payer behavior and process improvement
• Join the largest health system in West Virginia with strong institutional backing
• Be part of a team that values problem-solving, precision, and patient-centered care
✍️ Call to Action
If you’re an experienced RN with a sharp eye for detail, strong writing chops, and a passion for getting claims right—this is your lane. Apply now to become a key player in WVU Medicine’s revenue integrity and patient advocacy mission.