If you’re a licensed nurse who likes digging into charts, applying criteria, and writing clean clinical rationale, Acentra Health is hiring a Clinical Appeals Specialist to review medical records and support appeal decisions tied to contract requirements.
About Acentra Health
Acentra Health supports better health outcomes through technology, services, and clinical expertise, partnering heavily in the public sector. Their culture theme is “Lead the Way,” meaning ownership, problem-solving, and steady execution.
Schedule
- Full-time
- Remote within the United States
- Must work Eastern Time, Monday through Friday
What You’ll Do
- Review medical records using clinical criteria and contract requirements
- Ensure case accuracy and turnaround times meet contract standards
- Manage daily queues and workload, adjusting your schedule to meet volume needs
- Support quality monitoring activities with your supervisor
- Stay current on review processes and clinical practice updates
- Serve as a liaison for provider customer service issues and problem resolution
- Complete applicable review types as workload requires
- Maintain professional relationships with internal and external customers
- Attend trainings and scheduled meetings
- Cross-train to support team coverage and flexibility
- Follow corporate policies, including HIPAA Privacy and Security Rules
What You Need
- Active, unrestricted LPN or RN license (required)
- Associate’s or Bachelor’s degree in a related field (required)
- LPN track: Associate degree, practical nursing diploma, or certificate program per state requirements
- 3+ years of experience in healthcare environments supporting both members and providers (required)
- Knowledge of medical records, terminology, and disease processes (preferred)
- Strong clinical assessment + critical thinking (preferred)
- Excellent written and verbal communication (preferred)
Benefits
- Comprehensive health plans
- Paid time off
- Retirement savings
- Corporate wellness
- Educational assistance
- Corporate discounts
- More standard employee benefits
Pay
- $28.37 – $39.19 per hour (range depends on experience/skill level)
Real talk: this role is built for someone who can be fast and precise without getting sloppy. If your resume doesn’t clearly show “chart review + criteria-based decisions + tight documentation,” you’ll get filtered out.
Happy Hunting,
~Two Chicks…