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RN Appeals Analyst - Columbia

Kelly Services

Columbia, SC
Job Code:
Kelly Services
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Job Details

Job Title RN Appeals Analyst - Columbia

Jobid US33X4AP_BH1382632

Location: Columbia, SC, 29240, USA

Description **RN / Appeals Analyst**

Kelly Healthcare Resources (KHR) has an opportunity for an **RN/Appeals Analyst** to come and join our client located in **Columbia, SC** ! As the RN/Appeals Analyst with a large health insurance provider, you will research the substance of complex appeal or retrospective review requests including pre-pay and post-payment review appeal requests. You will provide thorough clinical review or benefit analysis to determine if the requested services meet medical necessity guidelines and document decisions within mandated timeframes and in compliance with applicable regulations or standards.

**Responsibilities of Job:**

+ Documents the basis of the appeal or retrospective review in an accurate and timely manner and in accordance with applicable regulations or standards.
+ Performs thorough research of the substance 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 projects including reviews of clinical information to identify quality of care issues.

+ Active RN license in South Carolina
+ 3+ years of clinical experience
+ Solid computer skills
+ Excellent attention to detail
+ Ability to work independently

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**Why Kelly** **®** **?**

**Why Kelly** **®** **?**

At Kelly Services®, we work with the best. Our clients include 95 of the Fortune 100™ companies, and more than 70,000 hiring managers rely on Kelly annually to access the best talent to drive their business forward. If you only make one career connection today, connect with Kelly.

**AboutKelly Services** **®**

As a workforce advocate for over 70 years, we are proud to directly employ nearly 500,000 people around the world and have a role in connecting thousands more with work through our global network of talent suppliers and partners. Revenue in 2017 was $5.4 billion. Visit and connect with us on Facebook , LinkedIn and Twitter .

Kelly Services is an equal opportunity employer including, but not limited to, Minorities, Females, Individuals with Disabilities, Protected Veterans, Sexual Orientation, Gender Identity and is committed to employing a diverse workforce. Equal Employment Opportunity is The Law. at

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