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Penn State Health Corporation
Location: US:PA: Hershey
Work Type: Full Time
FTE: 1.00
Shift: Day
Hours: 8:00a - 4:30p but flexible
Recruiter Contact: Brie Kissell at bkissell@pennstatehealth.psu.edu
SUMMARY OF POSITION Responsible for evaluating and appealing denied outpatient claims to ensure appropriate reimbursement for medically necessary services. This position requires strong clinical judgment, knowledge of payer guidelines, and the ability to craft clear, evidence-based appeal letters that effectively communicate the clinical rationale for treatment.
KEY RESPONSIBILITIES Review outpatient claim denials related to medical necessity and no authorization.
Analyze medical records and clinical documentation to determine the validity of payer denials.
Draft persuasive appeal letters using clinical evidence, payer policy, and regulatory standards.
Collaborate with physicians, coding staff, and revenue cycle teams to gather supporting documentation as needed.
Track appeal outcomes and identify trends to guide process improvement and reduce future denials.
Support departmental goals to optimize reimbursement and minimize financial loss.
MINIMUM QUALIFICATIONS Bachelor’s degree in Nursing required.
Currently licensed to practice as a Registered Nurse by state of employment or holds a multistate RN license through the Interstate Nurse Licensure Compact.
Prior experience with denial management and appeals required.
Familiarity with payer guidelines.
Excellent written and verbal communication skills.
BENEFITS Penn State Health offers exceptional opportunities to learn and grow, exposure to a wide patient population, and the ability to provide individualized, innovative, and specialized care to patients in the community.
Penn State Health offers an exceptional benefits package including medical, dental and vision with no waiting period as well as a Total Rewards Program that highlights a few of the many additional offerings below:
Be Well with Employee Wellness Programs, and Fitness Discounts (University Fitness Center, Peloton).
Be Balanced with Generous Paid Time Off, Personal Time, and Paid Parental Leave.
Be Secured with Retirement, Extended Illness Bank, Life Insurance, and Identity Theft Protection.
Be Rewarded with Competitive Pay, Tuition Reimbursement, and PAWS UP employee recognition program.
Be Supported by the HR Solution Center, Learning and Organizational Development and Virtual Benefits Orientation, Employee Exclusive Concierge Service for scheduling.
WHY PENN STATE HEALTH CORPORATION There are many ways to make an impact with one of the leading research, teaching, and clinical healthcare systems in the country. Through a combination of operational, corporate, clinical, and non‑clinical roles, we are advancing excellence and innovation in health care together as one team. As Penn State Health continues to evolve for the future, we are committed to hiring dedicated employees who are passionate about delivering the best possible support across our entire integrated health system.
Within Penn State Health’s Shared Services Entity, we encourage our employees at every turn to continue their education and advancement. Numerous opportunities are available for professional development and career growth.
State‑of‑the‑art equipment, endless learning, and a culture of excellence – that’s Penn State Health. But what makes our healthcare award‑winning? That’s all you.
This job posting is a general outline of duties performed and is not to be misconstrued as encompassing all duties performed within the position. Eligibility for shift differential pay based on the terms outlined in company policy or union contract.
All individuals (including current employees) selected for a position will undergo a background check appropriate for the position's responsibilities.
Penn State Health is an Equal Opportunity Employer and does not discriminate on the basis of any protected class including disability or veteran status. Penn State Health’s policies and objectives are in direct compliance with all federal and state constitutional provisions, laws, regulations, guidelines, and executive orders that prohibit or outlaw discrimination.
Union: Non Bargained