REGISTERED NURSE

Job description

Position Number: 22102669 County: Pulaski Posting End Date: March 12, 2026 Job Duties: Medical review and data correction of claims suspended for various edits, audits or pricing; Prepare and discuss specific reviews with medical consultants; Assists providers, members and vendors with issues related to medical review or coding via calls, emails, meetings or in person; Review provider reconsiderations for medical necessity and communicate decisions with vendors and providers; Maintain appropriate logs for various reviews; Complete monthly vendor audits including medical review as well as system processing review; Medical review of requests for special handled claims. Prepares approved claims for special processing through vendor; Quality Assurance Reviews; Maintains documentation including verifying uploaded documentation for accuracy. The formal education equivalent of a diploma, associates, or bachelor's degree in nursing. Must be licensed as a Registered Nurse by the Arkansas State Board of Nursing in accordance with ACA 17-87-301. Knowledge of ICD-10, HCPCS and CPT desired. Experience with electronic medical records a plus. Familiarity with medical record review and recent acut...