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 optionsApply Now
Apply Now
• 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 optionsApply Now
Apply Now