Georgia Licensed RN Clinical Auditor

Job Summary

A company is looking for an RN Clinical Auditor Claims and Coding Review (Outpatient Focus).

Key Responsibilities:

• Perform retrospective clinical/medical reviews of outpatient medical claims and appeal cases
• Apply knowledge of CPT/HCPCS codes and billing regulations for proper claim reimbursement
• Document audit findings and provide comprehensive summaries for appeals and claim denials

Required Qualifications:

• Graduate of an Accredited School of Nursing
• Active, unrestricted RN license in good standing
• Minimum of 3 years of clinical nursing experience
• At least 1 year of utilization review or claims review experience
• Minimum of 2 years of experience in claims auditing or medical necessity review