Nurse Auditor

Job Summary

A company is looking for a Nurse Auditor to perform specialized administrative duties within the billing and reimbursement services department.

Key Responsibilities

• Perform regular audits and review medical records to justify levels of care
• Prepare clinical reconsideration and appeal letters for authorization and medical necessity denials
• Conduct various denial reviews, including DRG downgrades and payer utilization review audits

Qualifications and Requirements

• Registered Nurse or Licensed Vocational Nurse
• Experience in Utilization Review and Case Management
• Familiarity with preparing and submitting authorizations
• Experience using InterQual and/or MCG
• Inpatient clinical experience required