State Licensed Nurse Consultant

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