Clinical Audit Analyst II - RN Licensed

A company is looking for a Clinical Government Audit Analyst & Appeal Specialist II (Remote).

Key Responsibilities

Conduct thorough analyses of denials and ensure accurate coding while identifying overpayments and underpayments

Independently draft and submit comprehensive appeal letters to payors, ensuring compliance with relevant guidelines

Collaborate with clinical teams and management to identify denial patterns and develop strategies for appeals

Required Qualifications

Bachelor's degree in a work-related discipline / field from an accredited college or university

Minimum two (2) years of progressive denials and appeals experience

Knowledge of medical and insurance terminology, coding structures, and billing forms

Licensure or certification in coding or clinical documentation improvement required within 180 days

Proficiency in computer systems and software, including EPIC and Microsoft Office