Job Summary
A health insurance company is searching for a person to fill their position for a Remote Bilingual Spanish Nurse Auditor 2 and RN Reviewer.
Must be able to:
- Perform clinical audit/validation processes to ensure that medical record documentation and diagnosis coding for services rendered is complete, compliant and accurate to support optimal reimbursement
- Focus on Medicare/Medicaid/Commercial reviews for the SIU Non Lab team
- Apply clinical and coding experience to conduct reviews of provider codes and billing
Applicants must meet the following qualifications:
- Fluency in English/Spanish; ability to speak, read and write in both languages without limitations or assistance
- Ability to take a Language Proficiency Assessment in English/Spanish
- Active and Valid RN license in PR and the US
- 2+ years of clinical experience (e.g. Review)
- Knowledge and familiarity of CPT Codes
- Ability to understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas
