State Licensed Nurse Consultant

Job Summary

To support healthcare providers, the full-time remote Denial Prevention Nurse Consultant will analyze medical records to validate billable services, construct appeals for payment, and provide clients with revenue cycle analysis and remediation recommendations.

Key responsibilities

• Build and maintain strong relationships with clients, payors, and internal personnel
• Analyze medical documentation for accuracy in billing and validate services rendered
• Research and interpret payer policies and prepare appeals for denied claims

Required qualifications

• Registered Nurse (RN) with a college degree or diploma from a nursing school
• Minimum of 5 years of clinical nursing experience in a hospital setting, preferably in ER or Critical Care
• Proficiency with Interqual and MCG guidelines for claim appeals
• Understanding of patient accounting documents such as UB04 and EOB
• Experience with healthcare billing software and databases, such as EPIC or Cerner