Clinical Appeals Nurse - Full Time Remote - Jefferson Health. Articulates the job's main responsibilities. This is not intended to be an exhaustive list of all essential functions or all duties performed. The essential functions listed below and percentage of time may vary between departments and locations, and are subject to change based on management discretion and organizational needs. Other responsibilities may be assigned at the discretion of management to meet organizational needs. Creates an appeal letter to uphold the procedure based on medical policy guidelines of the payor and the documentation found in the hospital/physician information system. Facilitates write off accounts that cannot provide adequate medical necessity or documentation for the payor to meet their guidelines. Investigates and coordinates completion of patient records required to retrospectively precertify accounts and appeal insurance denials. Contacts insurance companies and conducts appeals via telephone or email. Coordinates appeals that need a physician's input for the payor and writes off claims that have no further appeal rights. Identifies areas for revenue loss due to documentation or processes not being reimbursable thru payors. Ensures that all appeals are sent to the correct payor within the appeal guidelines. Ensures compliance with regulatory and accrediting requirements. Reviews claim documentation and pulls supporting medical documentation from the system to support the medical policy guidelines of the payor. Searches for supporting clinical evidence to support appeal arguments when existing resources are unavailable. Work Shift. Workday Day (United States of America)Worker Sub Type. Regular. Employee Entity. Thomas Jefferson University. Primary Location Address 1101 Market, Philadelphia, Pennsylvania, United States of America.