South Carolina Licensed Nurse Auditor

Job Summary

A company is looking for a Remote Nurse Auditor Non Exempt.

Key Responsibilities

• Review denied claims from all payers regarding medical necessity and appropriate settings
• Ensure accurate processing and appealing of denied claims to maximize reimbursement
• Communicate denial trends and collaborate with interdepartmental staff and clinicians

Required Qualifications, Training, and Education

• Bachelor of Nursing degree preferred
• Minimum of one year of work experience as a registered nurse required
• Licensure as a registered nurse by the South Carolina Board of Nursing or a compact state
• Current Basic Life Support (BLS) certification required
• RN staff must enroll in an accredited BSN program within two years if hired with an Associate or Diploma degree