RN Appeals Analyst: Medical Records & Denials (Contract)

TALENT Software Services; Columbia (SC); On-site; USD 37,000 - 50,000; Full time

Job summary

TALENT Software Services in Columbia, SC is seeking a qualified registered nurse for a clinical review role focused on medical records and provider appeals/denials. This is not bedside nursing; you will determine whether denials should be upheld or overturned, with emphasis on accurate coding and documentation.

The position is onsite, local candidates only, schedule Monday–Friday 8am–5pm with some flexibility.

Qualifications

• 3 years of clinical experience; or 2 years of clinical experience plus 1 year of utilization/medical review, quality assurance, or home health experience
• Active, unrestricted RN license in the state of hire or active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC)
• Healthcare insurance experience preferred

Responsibilities

• Day-to-day work will focus on reviewing medical records and provider appeals/denials, confirming appropriate coding, and determining whether a denial should be upheld or overturned.
• Please ensure candidates are genuinely interested in an appeals/clinical review role and understand this is not a traditional bedside RN position before submitting.

Education

Associate Degree in Nursing

Job description

TALENT Software Services in Columbia, SC is seeking a qualified registered nurse for a clinical review role focused on medical records and provider appeals/denials. This is not bedside nursing; you will determine whether denials should be upheld or overturned, with emphasis on accurate coding and documentation.

The position is onsite, local candidates only, schedule Monday–Friday 8am–5pm with some flexibility.