Clinical Auditor with RN License

A company is looking for a Clinical Auditor 2.

Key Responsibilities

Performs audits of medical records for denials review, defense audits, disallowed charges, and utilization reviews

Completes analysis of records against established criteria to determine compliance with patient condition and care standards

Organizes and prioritizes multiple cases, enters audit findings into the client's computer system, and composes appeal letters

Required Qualifications

RN / Case Management / Utilization Review / Coding or clinical certification with a BS / BA preferred, or equivalent technical experience

3 to 5 years of clinical or clinical auditing experience in case management, Medicare appeals, or denials management

Knowledge of Milliman (MCG) or InterQual criteria preferred

Experience in medical records review, claims processing, or utilization / case management

Proficiency in Microsoft Outlook, Word, Excel, and navigating electronic documentation systems