RN Appeals Analyst

Palmetto GBA
Washington, District of Columbia, United States
Full Time
Remote
Mid
USD 53,462 – 102,258
Associate Degree
Healthcare Healthcare Life Sciences

Posted 3 days ago

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Excellent 4.7

Job summary

Researches complex appeal requests and provides clinical review to determine medical necessity compliance, documenting decisions accurately within regulatory standards.

Responsibilities

The RN Appeals Analyst researches complex appeal and retrospective review requests to determine medical necessity based on clinical documentation and contractual requirements. They document decisions accurately within mandated timeframes while adhering to confidentiality regulations and quality of care standards.

Qualifications

appeals process benefit analysis clinical experience confidentiality regulations documenting decisions healthcare systems medical necessity medical review regulations compliance researching appeals

Candidates must hold an Associate degree in Nursing and an active, unrestricted RN license. The role requires at least two years of clinical experience combined with one year of utilization review or quality assurance experience.

English

Benefits

  • 401(k) retirement savings plan
  • Subsidized health plans
  • Free vision coverage
  • Life insurance
  • Paid annual leave
  • Nine paid holidays
  • On-site cafeterias
  • Fitness centers
  • Wellness programs
  • Tuition assistance
  • Service recognition
  • Incentive plan
  • Merit plan
  • Continuing education funds

Company

Palmetto GBA

Palmetto GBA

linkedin
Information Technology & Services
Location
Washington, District of Columbia, United States

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Excellent 4.7
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