Ternium Revenue Cycle Management · 8 hours ago
Clinical Review Nurse
United States
Full-time
Remote
Mid, Senior Level
$65K/yr - $85K/yr
5+ years expTernium is a leading advocate in healthcare revenue solutions, specializing in resolving complex healthcare insurance claim denials and delays. They are seeking a Clinical Review Nurse to analyze denied insurance claims, draft persuasive appeal letters, and collaborate with legal teams to support hospitals in recovering lost revenue.
Hospital & Health Care
Responsibilities
Analyze denied insurance claims and complete medical records
Apply clinical reasoning, national criteria (InterQual/Milliman), and best practices to determine if appeals are justified
Draft persuasive, medically sound appeal letters that clearly support the need for treatment or services
Collaborate with our legal team to ensure appeals are compelling and complete
Stay informed on healthcare regulations, payer trends, and clinical updates
Qualification
Required
RN License (required)
5+ years of acute hospital experience (required)
Preferred
Certification in Case Management, Legal Nurse Consulting, or Coding is a plus
Experience and knowledge of managed care contracts, account receivables and revenue cycle functions (preferred)
Experience and success in medical record chart review and appealing managed care denials (preferred)
Benefits
401(k) with corporate match
Comprehensive health, dental, and vision insurance
Flexible schedule and paid time off
Access to professional development, mentorship, and upward mobility within a thriving company
Life insurance
Performance-based bonuses
Company
Ternium Revenue Cycle Management
At Ternium, we specialize in resolving complex healthcare insurance claim denials and delays.
51-200 employees
Funding
Current Stage
Growth StageCompany data provided by crunchbase