New

Clinical Appeals LVN

TEKsystems
$26.00 - $30.00 / hr
life insurance, sick time, 401(k), retirement plan
United States, California, San Bernardino
Dec 12, 2025
Description We are seeking a dedicated Clinical Appeals Nurse to join our Revenue Cycle Management team. The ideal candidate will be responsible for managing clinical denials related to medical necessity, level of care, and delays in service. This role involves reviewing medical records, preparing clinical documentation to support appeals, and following up on submitted appeals. The Clinical Appeals Specialist will work closely with a team of Licensed Vocational Nurses (LVNs) and Registered Nurses (RNs) to ensure comprehensive and accurate appeal submissions. they are going to be looking at longer stay denials as far as inpatient because we do have a vendor that works our short stay admissions and denials. So, you know, like one to three day stays. So the ones that, the current position reviews is basically more than that. And so you may have, you know, longer stays that could be, you know, five days to like 100 days plus, yeah, and so, yeah, so which require a little bit more time because I have to sift through the medical records, you know, and try to, you know, come up with, the narrative and the, for the case and, you know, make sure that, you know, we have all the documentation to support it. medical necessity level of care, you know, DRG revisions, you know, delay in service, barren days, which is the same thing, you know, not meeting medical necessity for inpatient, once the follow up and the denial folks are following up on accounts and they determine that there's a clinical appeal denial, then they'll submit them to our team through the system. And so that goes into a work queue. And then I have two nurses. They're lvns and so, you know, that review them and see if we have enough clinical documentation to support an appeal. So they determine whether we're going to send one or we're going to accept it. So they do that review and then, you know, send the clinical appeal, and then we do have a follow up person that just does follow up. Skills clinical data analysis, appeals, medical reimbursement, clinical review, collections medical Top Skills Details clinical data analysis,appeals,medical reimbursement,clinical review,collections medical Additional Skills & Qualifications 1+ Years of experience in reviewing medical records 1+ years of experiences in appeals and denials High School Diploma Experience Level Intermediate Level Job Type & LocationThis is a Contract position based out of San Bernardino, CA. Pay and BenefitsThe pay range for this position is $26.00 - $30.00/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 TypeThis is a fully onsite position in San Bernardino,CA. Application DeadlineThis position is anticipated to close on Dec 24, 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.