Clinical Appeals Advocate

• Assess cases, develop appeal strategies, gather clinical documentation, and prepare persuasive appeal submissions for commercial and government payers
• Communicate with patients to explain appeal strategies, outline their responsibilities, and support preparation for hearings when applicable
• Create clinical case summaries and strengthen documentation for challenging payers or those with strict coverage criteria
• Process favorable appeal decisions promptly, negotiate payment rates through letters of agreement, and determine appropriate resolutions when denials are upheld
• Build and maintain professional relationships with case managers and medical directors to promote positive patient outcomes
• Deliver a superior customer experience by discussing payer policies, coverage criteria, benefit limitations, potential costs, and product information with patients and healthcare teams
• Ensure adherence to Hillrom and third‑party payer policies while maintaining high standards of quality, compliance, and team contribution
• Seek ongoing learning opportunities, support workload coverage, and perform additional duties or projects as assigned

• Registered Nurse (RN), Respiratory Therapist (RT), or Licensed Practical Nurse (LPN) required, with active state licensure or certification
• Associate degree or higher, or equivalent work experience in a related clinical or reimbursement field
• Minimum of 3 years of experience reviewing medical records and securing third‑party reimbursement preferred
• Knowledge of federal, state, and local regulations, including HIPAA requirements and payer guidelines
• Exceptional written, verbal, and interpersonal communication skills with strong attention to detail
• Ability to multitask effectively, prioritize critical responsibilities, and manage time independently
• Strong critical‑thinking and problem‑solving abilities, with comfort working both independently and within a team
• Proficiency in Microsoft Office and related software tools

Minimum of 3 years of experience reviewing medical records and securing third‑party reimbursement

• Medical and dental coverage that start on day one
• Insurance coverage for basic life, accident, short-term and long-term disability, and business travel accident insurance
• Employee Stock Purchase Plan (ESPP), with the ability to purchase company stock at a discount
• 401(k) Retirement Savings Plan (RSP), with options for employee contributions and company matching
• Flexible Spending Accounts
• Educational assistance programs
• Paid holidays
• Paid time off ranging from 20 to 35 days based on length of service
• Family and medical leaves of absence
• Paid parental leave
• Commuting benefits
• Employee Discount Program
• Employee Assistance Program (EAP)
• Childcare benefits