Denial Prevention Nurse Consultant

About the role

Revecore is seeking a Denial Prevention Nurse Consultant to join its specialized claims management team. The consultant will review medical records and documentation to build strong, evidence‑based appeals for denied claims, helping hospitals recover revenue while ensuring compliance with payer guidelines.

Key responsibilities

• Analyze medical records, tests, procedures, and pharmaceuticals to validate billing accuracy.
• Research commercial and governmental payer policies, clinical abstracts, and studies to support claim appeals.
• Contact insurance companies to resolve underpayments, obtain missing information, and negotiate adjustments.
• Prepare and submit correspondence, including letters, emails, online inquiries, appeals, and reports.
• Perform denial trending, identify revenue‑cycle fail points, and provide best‑practice recommendations.
• Maintain confidentiality in compliance with company policy and HIPAA.
• Lead client meetings and deliver consulting services related to medical necessity and payer criteria.

Required profile

• College degree or diploma from a school of nursing; must be a Registered Nurse (RN).
• Clinical nursing experience in a hospital or similar setting.
• Strong understanding of medical billing, managed‑care contracts, and denial management processes.
• Excellent communication skills for interacting with clients, payors, and internal teams.

Required skills

What we offer

• Paid training and incentive plans.
• Medical, dental, vision, and life insurance benefits effective day 1.
• Excellent work‑life balance and 12 paid holidays plus generous PTO.
• Employee Resource Groups fostering inclusion.
• 401(k) matching contributions.
• Career growth opportunities within a technology‑driven environment.