Our client, a leader in the healthcare industry, is seeking an Analyst, Appeals to join their team. As an Analyst, Appeals, you will be part of the clinical review department supporting the appeals team. The ideal candidate will have strong analytical skills, excellent communication abilities, and a solid clinical background which will align successfully in the organization.
Job Title: Analyst, Appeals
Location: Columbia, SC
Pay Range: Not specified
What's the Job?
- Research the substance of complex appeal or retrospective review requests including pre-pay and post-payment review appeal requests.
- Provide thorough clinical review or benefit analysis to determine if the requested services meet medical necessity guidelines.
- Document decisions within mandated timeframes and in compliance with applicable regulations or standards.
- Perform thorough research of service appeals based on clinical documentation, contractual requirements, and policies.
- Conduct special projects including reviews of clinical information to identify quality of care issues.
Want more jobs like this?
Get jobs in Columbia, SC delivered to your inbox every week.
What's Needed?
- Associate Degree in Nursing or Graduate of an Accredited School of Nursing.
- 2 years clinical experience plus 1 year in utilization/medical review, quality assurance, or home health.
- An active, unrestricted RN license from the United States and in the state of hire.
- Strong clinical experience including home health, rehabilitation, or broad medical surgical experience.
- Working knowledge of managed care and various forms of healthcare delivery systems.
What's in it for me?
- Opportunity to work in a dynamic and supportive environment.
- Gain valuable experience in appeals and utilization management.
- Collaborate with a knowledgeable and experienced team.
- Potential for remote work after an initial onsite period.
- Engagement in meaningful work that impacts patient care and quality.
If this is a role that interests you and you'd like to learn more, click apply now and a recruiter will be in touch with you to discuss this great opportunity. We look forward to speaking with you!
About ManpowerGroup, Parent Company of: Manpower, Experis, Talent Solutions, and Jefferson Wells
ManpowerGroup® (NYSE: MAN), the leading global workforce solutions company, helps organizations transform in a fast-changing world of work by sourcing, assessing, developing, and managing the talent that enables them to win. We develop innovative solutions for hundreds of thousands of organizations every year, providing them with skilled talent while finding meaningful, sustainable employment for millions of people across a wide range of industries and skills. Our expert family of brands – Manpower, Experis, Talent Solutions, and Jefferson Wells – creates substantial value for candidates and clients across more than 75 countries and territories and has done so for over 70 years. We are recognized consistently for our diversity - as a best place to work for Women, Inclusion, Equality and Disability and in 2023 ManpowerGroup was named one of the World's Most Ethical Companies for the 14th year - all confirming our position as the brand of choice for in-demand talent.