Job Summary
A health insurance company has an open position for a Remote Senior Nurse Auditor.
Core Responsibilities of this position include:
- Identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by health care providers
- Correlating review findings with appropriate actions including provider education and recovery of monies
- Assisting with development of audit tools, policies and procedures and educational materials
Applicants must meet the following qualifications:
- Requires an AS/BS in nursing and 4 years of clinical nursing experience
- OR any combination of education and experience, which would provide an equivalent background
- Current unrestricted state RN license is required
- Requires knowledge of navigating through a medical record for auditing purposes
- Working knowledge of CPT/HCPCS and ICD- 9 and ICD-10 coding