RN Corporate Appeals Analyst: Clinical & Benefit Review

Spectraforce Technologies, Inc.; Columbia (SC); Sur place; USD 45 000 - 65 000; Plein temps

Résumé du poste

Spectraforce Technologies, Inc. is seeking an Corporate Appeals Analyst - RN in Columbia, SC for a short-term assignment.

The role focuses on researching complex appeal requests, performing clinical reviews, and documenting medical necessity findings to support payor decisions. The ideal candidate holds an active RN license in the United States and has hands-on clinical experience along with familiarity with utilization review and healthcare policies.

Qualifications

• Active RN licensure in the United States with an unrestricted license in the state of hire.
• Minimum 2 years of clinical experience or 3 years of clinical experience plus 1 year utilization/medical review, quality assurance, and home health experience.
• Healthcare insurance familiarity preferred.

Responsabilités

• Researches complex appeal or retrospective review requests, including pre-pay and post-payment appeals.
• Provides clinical review or benefit analysis to determine medical necessity and documents decisions within required timeframes.
• Documents the basis of the appeal in accordance with regulations and standards; conducts thorough chart reviews and applies applicable policies.

Formation

Associate Degree - Nursing, or Graduate of Accredited School of Nursing

Description du poste

Spectraforce Technologies, Inc. is seeking an Corporate Appeals Analyst - RN in Columbia, SC for a short-term assignment.

The role focuses on researching complex appeal requests, performing clinical reviews, and documenting medical necessity findings to support payor decisions. The ideal candidate holds an active RN license in the United States and has hands-on clinical experience along with familiarity with utilization review and healthcare policies.