Ternium Revenue Cycle Management

Role Description As a Clinical Review Nurse, you won’t just review charts—you’ll write compelling clinical arguments that help hospitals recover millions in lost revenue due to denied insurance claims. You’ll use your nursing knowledge, attention to detail, and love of documentation to make a real difference—without ever setting foot in a courtroom or hospital shift. - Analyze denied insurance claims and complete medical records. - Apply clinical reasoning, national criteria (InterQual/Milliman), and best practices to determine if appeals are justified. - Draft persuasive, medically sound appeal letters that clearly support the need for treatment or services. - Collaborate with our legal team to ensure appeals are compelling and complete. - Stay informed on healthcare regulations, payer trends, and clinical updates. Qualifications - RN License (required) - 5+ years of acute hospital experience (required) - Certification in Case Management, Legal Nurse Consulting, or Coding is a plus. - Possess knowledge and experience with national clinical criteria applied in case management including InterQual and Milliman standards. - Experience and knowledge of managed care contracts, account receivables and revenue cycle functions (preferred). - Experience and success in medical record chart review and appealing managed care denials (preferred). Benefits - 100% Remote: Work from anywhere in the U.S. while making a tangible difference. - Competitive Salary: $65,000–$85,000 per year (commensurate with experience). - Robust Benefits Package: 401(k) with corporate match, comprehensive health, dental, and vision insurance. - Work-Life Balance: Flexible schedule and paid time off. - Career Growth: Access to professional development, mentorship, and upward mobility within a thriving company. - Additional Perks: Life insurance and performance-based bonuses.

• Represent healthcare providers in administrative appeals for denied insurance claims. • Develop creative and effective legal arguments to overturn claim denials. • Craft compelling and well-researched appeal letters to insurance companies and benefit administrators. • Utilize provider manuals and managed care contracts to dispute unjust denials. • Work closely with provider representatives and resolution teams to navigate complex claims. • Identify industry trends and provide valuable insights to enhance recovery strategies. • Conduct legal research and analysis to support business objectives.

Welcome! We’re excited you’re exploring opportunities with us. Below you’ll find details about the role, the impact you can make, and what we’re looking for in an ideal candidate. We’re passionate about building a team that shares our values and brings diverse perspectives to help us grow and succeed together. Revenue Cycle Associate - Denials Specialist (Remote) Join Our Team at Ternium RCM – A Leading Advocate in Healthcare Revenue Cycle Solutions! Are you ready to make a real impact on the healthcare industry? Ternium RCM is seeking a Denials Specialist to help us empower hospitals and health systems across the country. If you're passionate about optimizing processes and improving healthcare outcomes, this is your chance to be part of a growing, innovative team. Who We Are: At Ternium, we specialize in resolving complex healthcare insurance claim denials and delays. Our mission is to empower hospitals and health systems by optimizing their revenue cycle, allowing them to focus on what matters most—patient care. With a dedicated team of professionals, we consistently deliver outstanding results, increasing net patient revenue, improving cash flow, and reducing operational costs while enhancing the patient experience. What You’ll Do: As a Revenue Cycle Associate – Denials Specialist, you will play a vital role in ensuring smooth communication between clients, internal teams, and insurance carriers. Your focus will be on supporting financial health through effective denial resolution and process improvement. Key Responsibilities: - Respond to client or team information requests in a timely and professional manner. - Communicate with insurance carriers to resolve claim issues that hinder cash flow. - Identify training needs based on internal QA findings, reviews, and client feedback. - Contribute to the development and refinement of training materials - Maintain proactive and clear communication with clients regarding updates and resolutions. What You Bring to the Table: - Foundational knowledge of revenue cycle processes. - Experience in healthcare, insurance claims, billing, or denial management. - Prior experience in a hospital CBO setting is strongly preferred. - Familiarity with the EPIC patient accounting system is a plus. - Excellent organizational skills and strong time management abilities. Why Join Us? - Flexible Work Style: Work from anywhere within the United States while making a tangible difference. - Competitive Salary: $40,000 - $50,000 - Robust Benefits Package: 401(k) with corporate match, comprehensive health, dental, and vision insurance. - Work-Life Balance: Flexible schedule and paid time off. - Career Growth: Access to professional development, mentorship, and upward mobility within a thriving company. - Additional Perks: Life insurance and performance-based bonuses. A Culture of Inclusion & Opportunity Ternium is an equal opportunity employer that values diversity and inclusion. We do not discriminate based on age, race, national origin, citizenship status, disability, religion, gender, sexual orientation, gender identity, genetic information, marital status, veteran status, or any other protected characteristic. We are also committed to maintaining a supportive and harassment-free work environment. Ready to Elevate Your Legal Career? Apply today and become a valued member of the Ternium team. Thank you for considering a career with us! We encourage you to apply even if you don’t meet every requirement — we value passion, potential, and a willingness to learn. We look forward to reviewing your application and hopefully welcoming you to our team.

• Lead a team responsible for delivering outstanding client outcomes across Ternium’s denial management engagements • Serve as a trusted strategic advisor to Revenue Cycle and Finance executives • Own and manage executive-level relationships with VPs of Revenue Cycle, CFOs, and Denials Leadership • Serve as senior escalation point for client performance, operational, or contractual matters • Lead Quarterly Business Reviews (QBRs) • Drive and monitor KPIs including recovered revenue, aging, inventory velocity, and payer performance • Partner cross-functionally with Operations, Sales, Denials Insights, and Leadership • Lead, coach, and develop a team of client-facing leaders