Clinical Denial Appeals Specialist

TEKsystems
$40.00 - $54.00 / hr
life insurance, sick time, 401(k), retirement plan
United States, Maryland, Annapolis
Aug 09, 2025
The Clinical Denials Appeals Specialist plays a critical role in identifying, mitigating, and preventing clinical denials. This is a Direct Placement opportunity and not a contract. This individual will review initial clinical denials, determine appropriate next steps, and lead appeals efforts by analyzing medical necessity, addressing authorization issues, and resolving coverage-related discrepancies. The specialist will also collaborate with clinical and revenue cycle teams to address root causes and implement process improvements. Hybrid Schedule: 4 days onsite and 1 in office per week Location: Annapolis, MD Pay Rate: $45-54/HR Key Responsibilities * Review clinical denials and initiate appeals in accordance with internal protocols * Conduct medical necessity reviews and prepare clinical documentation summaries * Communicate with payer representatives, mediators, arbitrators, and legal counsel as needed * Identify documentation gaps and collaborate with clinical teams on quality improvement initiatives * Evaluate charge capture and coding accuracy; support revenue cycle enhancements * Assist case management with concurrent review processes * Review high-risk/high-dollar accounts pre-claim submission to prevent denials * Analyze denial data to identify trends and recommend process improvements * Participate in denial prevention initiatives and task force meetings Required Experience: * Minimum of 3 years in one or more of the following: clinical, case management, denials, or billing * Must be a Registered Nurse or Licensed Nurse Practitioner Knowledge & Skills: * Strong understanding of medical coding, billing, and audit processes * Familiarity with National and Local Coverage Determinations * Proficient in interpreting medical records and terminology * Knowledge of medical necessity screening tools (e.g., Milliman, InterQual) * Experience with EHR systems (Epic, Cerner, MEDITECH) and Microsoft Office Suite * Excellent communication, time management, and prioritization skills Why Apply? * Work with a top-tier healthcare system committed to excellence * Hybrid flexibility with a supportive and collaborative team * Opportunity to drive meaningful change in healthcare reimbursement * Competitive salary and benefits package Pay and Benefits The pay range for this position is $40.00 - $54.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: * Medical, dental & vision * Critical Illness, Accident, and Hospital * 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available * Life Insurance (Voluntary Life & AD&D for the employee and dependents) * Short and long-term disability * Health Spending Account (HSA) * Transportation benefits * Employee Assistance Program * Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a hybrid position in Annapolis,MD. Application Deadline This position is anticipated to close on Aug 22, 2025. h4>About TEKsystems: We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. About TEKsystems and TEKsystems Global Services We're a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We're a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We're strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We're building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.