Clinical Auditor with RN License

Job Summary

A company is looking for a Clinical Auditor 2.

Key Responsibilities

• Perform audits of medical records for denials review, defense audits, and utilization reviews
• Analyze records against established criteria to determine compliance with patient care standards
• Compose appeal letters and manage multiple cases to ensure efficient workflow and resolution

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 relevant fields
• Knowledge of Milliman (MCG) or InterQual criteria preferred
• Experience in medical records review and claims processing
• Proficiency in Microsoft Outlook, Word, Excel, and electronic documentation systems