RN Nurse Consultant

Job Summary

To support hospitals in enhancing patient care, the full-time remote RN Nurse Consultant will analyze medical records for billing accuracy, identify trends in revenue cycle issues, and provide best practice recommendations to clients.

Key responsibilities

• Analyze medical documentation to validate services and prepare appeals for denied claims
• Identify fail points in the revenue cycle and provide remediation recommendations to clients
• Maintain communication with payors and clients regarding claims status and resolve underpayments or denials

Required qualifications

• RN with a college degree or diploma from a nursing school
• Minimum 5 years of experience in utilization review or patient accounting
• Clinical nursing experience in a hospital setting, preferably in ER or Critical Care
• Proficiency with Interqual and MCG guidelines for claim appeals
• Familiarity with healthcare billing software and patient accounting documents (UB04, EOB)