South Carolina Licensed Nurse Auditor

Konsus, Inc. (Superside); United States; Remote; USD 65,000 - 85,000; Full time

Job summary

A leading healthcare company is seeking a Remote Nurse Auditor to review and process denied claims related to medical necessity. The ideal candidate will have a Bachelor's degree in Nursing, required nursing licensure, and experience in claims management. This role involves collaboration across departments to enhance reimbursement efforts and requires an active BLS certification.

Qualifications

• Minimum of one year of work experience as a registered nurse required.
• RN must enroll in an accredited BSN program within two years if hired with an Associate or Diploma degree.

Responsibilities

• Review denied claims from all payers regarding medical necessity.
• Ensure accurate processing and appeal of denied claims.
• Communicate denial trends and collaborate with staff and clinicians.

Skills

Review denied claims

Interdepartmental collaboration

Denial trend communication

Education

Bachelor of Nursing degree

Registered Nurse licensure

Current Basic Life Support (BLS) certification

Job description

A company is looking for a Remote Nurse Auditor Non Exempt.

Key Responsibilities

• Review denied claims from all payers regarding medical necessity and appropriate settings
• Ensure accurate processing and appealing of denied claims to maximize reimbursement
• Communicate denial trends and collaborate with interdepartmental staff and clinicians

Required Qualifications, Training, and Education

• Bachelor of Nursing degree preferred
• Minimum of one year of work experience as a registered nurse required
• Licensure as a registered nurse by the South Carolina Board of Nursing or a compact state
• Current Basic Life Support (BLS) certification required
• RN staff must enroll in an accredited BSN program within two years if hired with an Associate or Diploma degree