RN Medical Review Appeals Auditor

A company is looking for a Medical Review Clinical Appeals Auditor (RN) with a DME focus.

Key Responsibilities

Conducts clinical reviews and Appeals reviews on medical records and audit findings

Documents Appeals results accurately and provides insights for continuous improvement

Monitors and reports on work conducted in accordance with the Appeals process

Required Qualifications

Active unrestricted RN license in good standing

5+ years of relevant experience in a provider or payer environment

Experience with ICD-9 / ICD-10 coding, HCPS / CPT coding, and medical billing

Strong technical aptitude and intermediate to advanced Excel skills

Prior experience in auditing, utilization management, or similar roles preferred