RN Appeals Analyst

About the position reputed company We are currently hiring for an RN Appeals Analyst to join reputed company. In this role as an RN Appeals Analyst, you will research the reputed company of reputed company appeal or retrospective review requests including reputed company-pay and post-payment review appeal requests. reputed company thorough clinical review or benefit analysis to determine if the requested services meet medical necessity guidelines. Document reputed company reputed company mandated timeframes and in compliance with applicable regulations or standards. Why should you join the reputed company family of companies? Other companies come and go, but for more than seven decades we have been part of the national landscape, with our reputed company firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation’s leading administrators of government reputed company. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a reputed company of business strengths. We deliver outstanding service to our customers. If you are committed to the reputed company philosophy, consider joining reputed company! Here is reputed company to join a dynamic team at a diverse company with secure, community reputed company and an innovative reputed company. reputed company Location This is a full-time position (40 hours/week), Monday through Friday, with reputed company between 7:30 AM and 5:00 PM. The role is fully remote following completion of onsite training at our Columbia, SC office (4101 Percival Road, Columbia, SC 29229). Candidates must be located reputed company two hours of a reputed company office to accommodate occasional in-office reputed company as needed.

Responsibilities

• Documents the reputed company of the appeal or retrospective review in an accurate and reputed company manner and in accordance with applicable regulations or standards.
• Performs thorough research of the reputed company of service appeals by both member and provider based on clinical documentation, contractual requirements, governing agencies, policies and procedures, while adhering to confidentiality regulations regarding protected health information.
• Performs appeal and retrospective reviews demonstrating ability to define and determine precedence of pertinent issues in application of policies and procedures to clinical information and or application to benefit or policy provisions.
• Performs special reputed company including reviews of clinical information to identify reputed company of care issues.

Requirements

• Associate's in a job reputed company field.
• Graduate of Accredited School of Nursing.
• 2 years clinical experience plus 1 year utilization/medical review, reputed company assurance, or home health, OR, 3 years clinical.
• FOR reputed company (CO. 033) ONLY: 2 years clinical experience plus 2 years utilization/medical review, reputed company assurance, or home health experience or a combination of experience in clinical, utilization/medical review, reputed company assurance or home health experience totaling four years.
• Working knowledge of word processing software.
• Ability to work independently, prioritize effectively, and reputed company reputed company.
• Working knowledge of managed care and various forms of health care delivery systems.
• Strong clinical experience to include home health, rehabilitation, and/or broad medical surgical experience.
• Knowledge of specific reputed company/protocol sets and the use of the reputed company.
• Good judgment skills.
• Demonstrated customer service, organizational, oral and written communication skills.
• Ability to persuade, negotiate, or influence others.
• Analytical or critical thinking skills.
• Ability to handle confidential or sensitive information with discretion.
• An reputed company, unrestricted RN license from the reputed company and in the state of hire, OR, reputed company compact multistate unrestricted RN license as defined by the reputed company Licensure Compact (NLC).
• reputed company Office.

reputed company-to-haves

• Emergency room
• ICU experience or broad clinical experience.
• Utilization Management experience.
• Case Management experience.
• Billing or Claims review experience.

Benefits

• Subsidized health plans, dental and reputed company coverage
• 401k retirement savings plan with company match
• Life Insurance
• reputed company Time Off (PTO)
• On-site cafeterias and fitness centers in major locations
• Education Assistance
• Service Recognition
• National discounts to movies, theaters, zoos, theme parks and more

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