Corporate Appeals Analyst - RN

CEI; Columbia (SC); On-site; USD 36,000 - 51,000; Full time

Job summary

CEI seeks a Corporate Appeals Analyst - RN for an on-site role in Columbia, SC. The position focuses on clinical review of provider and member appeals and retrospective reviews, assessing medical records and benefit criteria to decide denials within required timelines.

The ideal candidate holds an active SC RN license with 3+ years of clinical RN experience and can apply policies and regulations to clinical determinations while documenting decisions accurately.

Qualifications

• Active, unrestricted RN license (state of hire).
• 3+ years of clinical RN experience.
• Experience reviewing medical records and clinical documentation for appeals/denials.
• Ability to apply policies, procedures, and regulatory requirements to clinical determinations.
• Accurate, timely documentation of clinical decisions and rationale.
• Ability to prioritize multiple reviews and meet mandated turnaround times.

Responsibilities

• Review and analyze complex appeal and retrospective review requests (including pre-pay and post-payment).
• Evaluate clinical documentation to determine medical necessity and benefits eligibility.
• Research applicable regulations, policies, authorizations, and procedures relevant to each case.
• Assess and validate appropriate coding in support of review determinations.
• Document the basis of determinations accurately, clearly, and within mandated timeframes.
• Maintain confidentiality and comply with requirements related to protected health information.

Skills

Active RN license

Clinical experience

Medical records review

Policy compliance

Documentation accuracy

Prioritize workload

Education

Associate Degree in Nursing

Job description

Corporate Appeals Analyst - RN
Healthcare Columbia , South Carolina Contract On-Site Nov 5, 2026

Corporate Appeals Analyst - RN
Job at a Glance

• Location: Columbia, SC (On-site 5 days a week, 8-5)
• Contract: W2 only
• Pay: $31.59/hour + optional medical, dental, vision, 401(k) match
• Must have an active, unrestricted RN license in the state of South Carolina and 3+ years clinical RN experience

Overview

This on-site role focuses on clinical review of complex provider and member appeals and retrospective reviews. You will analyze medical records and benefit/policy criteria to determine whether denials should be upheld or overturned while meeting required timelines and compliance standards.

Key Responsibilities

• Review and analyze complex appeal and retrospective review requests (including pre-pay and post-payment).
• Evaluate clinical documentation to determine medical necessity and benefits eligibility.
• Research applicable regulations, policies, authorizations, and procedures relevant to each case.
• Assess and validate appropriate coding in support of review determinations.
• Document the basis of determinations accurately, clearly, and within mandated timeframes.
• Maintain confidentiality and comply with requirements related to protected health information.
• Support special projects, including identification of potential quality-of-care issues.

Required Skills

• Active, unrestricted RN license (state of hire) OR active compact multistate RN license (NLC).
• 3 years of clinical experience, OR 2 years clinical experience plus 1 year in utilization/medical review, quality assurance, and home health.
• Experience reviewing medical records and clinical documentation for appeals/denials.
• Ability to apply policies, procedures, and regulatory requirements to clinical determinations.
• Accurate, timely documentation of clinical decisions and rationale.
• Ability to prioritize multiple reviews and meet mandated turnaround times.

Education

• Associate Degree in Nursing or graduate of an accredited school of nursing.

Preferred Skills

• Healthcare insurance experience.
• Experience with benefit analysis related to coverage determinations.
• Experience supporting or identifying quality-of-care issues during clinical reviews.

Why Should I Apply?

If you are an RN who enjoys analytical, documentation-driven clinical work, this role offers the opportunity to apply your expertise to appeals and retrospective reviews in a structured, compliance-focused environment.

About CEI

As a trusted technology partner, CEI delivers solutions that help our customers transform their business and achieve meaningful results. From strategy and custom application development through application management - our technology and digital experience services are tailored to meet each unique need of our customers. Our staffing solutions bring specialized skills to complement our customers' workforce and project requirements.

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