RN – Clinical Auditor 2
Job Description: • Perform audits of medical records for denials review, defense audits, disallowed charges, and utilization reviews • Complete analysis of records against established criteria • Determine, request, and obtain appropriate supporting documentation • Compose appeal letters addressing both contract issues and medically related issues • Organize and prioritize multiple cases for departmental workflow • Enter audit findings into computer systems • Function in a professional manner focusing on customer service Requirements: • RN/Case Management/Utilization Review/Coding clinical certification • 3 to 5 years of clinical experience or auditing experience • Knowledge of Milliman (MCG) or InterQual criteria preferred • Experience in medical records review, claims processing, or utilization/case management in a clinical practice or managed care organization • Fundamental knowledge of Medicare/Medicaid Guidelines • Proficiency in navigating the internet and multi-tasking with electronic documentation systems • Skilled with Microsoft Outlook, Word, Excel, and EMR Savista Benefits: • Health insurance • Professional development opportunities • 401(k) retirement plan • Remote work options Apply tot his job