Medovent Solutions is a nationally recognized healthcare staffing and consulting firm headquartered in Tampa Bay. We are proud to be named one of the Best Places to Work by the Tampa Bay Business Journal, included in the Fast 50 for fastest-growing companies in Tampa Bay, and honored as part of the prestigious Inc. 5000 list of America’s fastest-growing private companies. We are passionate about supporting healthcare organizations and professionals nationwide with expertise, innovation, and integrity.

Medical Necessity Appeals and Denials Specialist

Position Summary

Medovent Solutions is seeking experienced Medical Necessity Appeals and Denials Specialists to manage the complete appeals process for multiple healthcare organizations. This position requires direct appeals experience, strong clinical knowledge, and demonstrated expertise writing clear, persuasive, and well-supported appeal letters.

The ideal candidate will have a clinical nursing or medical coding background and be comfortable working across different healthcare environments, electronic medical record systems, and workflows. This is a fast-paced, production-focused position that requires exceptional communication, organization, and critical-thinking skills.

Key Responsibilities

• Manage medical necessity appeals through the complete end-to-end process.
• Review denied claims, medical records, clinical documentation, payer correspondence, and applicable coverage criteria.
• Evaluate the clinical basis for services and determine whether the medical record supports medical necessity.
• Research applicable clinical guidelines, payer policies, coding guidance, and regulatory requirements.
• Prepare clear, accurate, persuasive, and clinically supported appeal letters.
• Identify the root causes of denials and determine the appropriate appeal strategy.
• Ensure all appeals include relevant clinical evidence, documentation, and supporting rationale.
• Track appeal status, required documentation, filing deadlines, and outcomes through final resolution.
• Communicate effectively with clinical, coding, revenue cycle, and other operational teams.
• Work across multiple healthcare organizations and adapt quickly to different requirements, workflows, and electronic medical record systems.
• Use TruCode and other applicable technology to support review and appeal activities.
• Maintain an expected productivity level of seven to ten completed cases per hour while meeting established quality and accuracy standards.
• Maintain patient confidentiality and comply with all applicable regulatory, privacy, and organizational requirements.

Required Qualifications

• Professional experience managing medical necessity appeals.
• Demonstrated experience writing clinical appeal letters.
• Experience handling the complete appeals process from initial denial review through final resolution.
• Clinical nursing or medical coding background.
• Strong understanding of clinical documentation, medical necessity, and denial-management principles.
• Ability to interpret medical records, clinical findings, treatment plans, and payer correspondence.
• Excellent written and verbal communication skills.
• Strong critical-thinking, research, organizational, and problem-solving abilities.
• Ability to work accurately and efficiently in a fast-paced, production-focused environment.
• Ability to consistently complete seven to ten cases per hour while maintaining quality standards.
• Ability to transition between multiple healthcare organizations, systems, and workflows.

Preferred Qualifications

• Active nursing license or professional medical coding credential.
• Experience using TruCode.
• Experience working with multiple electronic medical record systems.
• Experience supporting hospital-based revenue cycle, utilization management, clinical documentation integrity, or denial-management functions.

Medovent Solutions offers an exceptional benefits package including a comprehensive medical/dental/vision plan, a 401(k) savings plan, paid holidays, and vacation pay.

Medovent Solutions is an Equal Opportunity Employer and does not discriminate in its employment practices on the basis of race, religion, sex, color, national origin, age, disability, citizenship, genetic information, veteran status or military service, or any other characteristic protected by federal or Florida law.