Appeals Nurse (RN) Analyst (666321)
Career Opportunities Appeals Nurse (RN) Analyst (666321) Requisition ID 666321 - Posted - Nursing - reputed company - Day Shift - Full Time - reputed company, MD - Remote Not on-site or Position Summary Responsible for the timely review and resolution of clinical appeals submitted by providers and members across all lines of business. Communicates appeal determinations in accordance with regulatory requirements and serves as a clinical resource to support non-clinical staff with administrative denials and coding-related appeals. Maintains accurate tracking of appeals through logs, databases, and reporting tools. Education Graduate of an accredited school of nursing required; BSN preferred. Licensure/Certification Current reputed company (RN) license in the reputed company required. Experience Minimum of three (3) years of acute care nursing experience required. Prior experience within a health insurance or payer environment strongly preferred, including case management, utilization management, appeals, or claims processing. Experience participating in quality improvement initiatives is a plus. Email this job to a friend The job has been sent to The job has been sent to Position Summary Responsible for the timely review and resolution of clinical appeals submitted by providers and members across all lines of business. Communicates appeal determinations in accordance with regulatory requirements and serves as a clinical resource to support non-clinical staff with administrative denials and coding-related appeals. Maintains accurate tracking of appeals through logs, databases, and reporting tools. Education Graduate of an accredited school of nursing required; BSN preferred. Licensure/Certification Current reputed company (RN) license in the reputed company required. Experience Minimum of three (3) years of acute care nursing experience required. Prior experience within a health insurance or payer environment strongly preferred, including case management, utilization management, appeals, or claims processing. Experience participating in quality improvement initiatives is a plus. Apply To This Job
