RN Clinical Auditor
Job Description:
• Perform complete government (MAC, CERT, RAC, OIG, ZPIC, UPIC, QIO, TPE, DRG), state (Medicaid, PERM) and commercial (Managed Medicare, Charge/Defense, Level of Care, Medical Necessity, Readmission) payer clinical audit reviews.
• Assist with analyzing and reviewing clinical audit and DRG clinical validation audits.
• Contact regulatory bodies such as MACs and payers to determine the reason for the audit.
• Review medical records to ensure compliance with healthcare standards and regulations.
• Analyze medical records and data to identify trends and discrepancies.
• Work effectively with healthcare providers, management, and other departments.
Requirements:
• 2+ years of regulatory audit experience, utilization review, clinical validation, denials or case management experience strongly preferred
• Experience in hospital operations, chart audit/review, and clinical education
• Ability to manage time, meet audit deadlines, and handle multiple tasks.
• Familiarity with electronic medical records (EMR) systems.
• Registered Nurse (RN) license required
Benefits:
• Bonus Incentives
• Paid Certifications
• Tuition Reimbursement
• Comprehensive Benefits
• Career Advancement
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Apply To this Job
• Perform complete government (MAC, CERT, RAC, OIG, ZPIC, UPIC, QIO, TPE, DRG), state (Medicaid, PERM) and commercial (Managed Medicare, Charge/Defense, Level of Care, Medical Necessity, Readmission) payer clinical audit reviews.
• Assist with analyzing and reviewing clinical audit and DRG clinical validation audits.
• Contact regulatory bodies such as MACs and payers to determine the reason for the audit.
• Review medical records to ensure compliance with healthcare standards and regulations.
• Analyze medical records and data to identify trends and discrepancies.
• Work effectively with healthcare providers, management, and other departments.
Requirements:
• 2+ years of regulatory audit experience, utilization review, clinical validation, denials or case management experience strongly preferred
• Experience in hospital operations, chart audit/review, and clinical education
• Ability to manage time, meet audit deadlines, and handle multiple tasks.
• Familiarity with electronic medical records (EMR) systems.
• Registered Nurse (RN) license required
Benefits:
• Bonus Incentives
• Paid Certifications
• Tuition Reimbursement
• Comprehensive Benefits
• Career Advancement
Apply tot his job
Apply To this Job