001 Blue Cross And Blue Shield Of South Carolina

RN Appeals Analyst

Nashvilleremotemid

Posted today · via Workday

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About this role

Summary Researches the substance of complex appeal or retrospective review requests including pre-pay and post-payment review appeal requests. Provides thorough clinical review or benefit analysis to determine if the requested services meet medical necessity guidelines. Documents decisions within mandated timeframes and in compliance with applicable regulations or standards. Description Logistics: CGS –one of BlueCross BlueShield's South Carolina subsidiary companies. Location This position is full time (40 hours/week) Monday-Friday from 8:00am – 5:00pm and will be fully remote. What You’ll Do: Documents the basis of the appeal or retrospective review in an accurate and timely manner and in accordance with applicable regulations or standards.…

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For this role: hipaa

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