RN Appeals Analyst Medicare Part B - CGS
Remote / Online - Candidates ideally in
Berry Hill, Davidson County, Tennessee, USA
Listed on 2026-01-26
Berry Hill, Davidson County, Tennessee, USA
Listing for:
Remote Jobs
Remote/Work from Home
position Listed on 2026-01-26
Job specializations:
-
Healthcare
Job Description & How to Apply Below
Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Comprehensive benefits including subsidized health plans, free vision coverage, and life insurance
- Paid annual leave that increases with tenure, plus nine paid holidays
- Incentive and merit plans to reward performance
- Continuing education funds for additional certifications and certification renewal
- Flexible work options available, including work-from-home or on-site arrangements
- Conduct thorough research and document the basis of appeals or retrospective reviews in a timely manner
- Analyze clinical documentation and contractual requirements to resolve service appeals from members and providers
- Perform appeal and retrospective reviews, ensuring compliance with policies and procedures
- Engage in special projects to identify quality of care issues through clinical information reviews
- Maintain confidentiality and adhere to regulations regarding protected health information
- Associate's degree in a job-related field or graduate of an accredited school of nursing
- Minimum of 2 years of clinical experience plus 1 year in utilization/medical review or quality assurance, or 3 years of clinical experience
- Active, unrestricted RN license from the United States or a compact multistate unrestricted RN license
- Strong clinical experience in home health, rehabilitation, or broad medical surgical settings
- Proficient in Microsoft Office and strong analytical or critical thinking skills
- Experience in Utilization Review or Medical Review
- Knowledge of MCS System and Medicare Part B
- Familiarity with claims systems and coding experience
- Ability to effectively use Microsoft Office applications, such as Word, PowerPoint, and Excel
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