RN Clinical Appeals Auditor

Job Summary

A company is looking for a Medical Review Clinical Appeals Auditor (RN) - SNF/MDS.

Key Responsibilities

• Conducts clinical reviews and Appeals reviews on medical records and audit findings
• Documents Appeals results accurately and provides feedback for continuous improvement
• Monitors and reports on work conducted in accordance with the Appeals process

Required Qualifications

• Active unrestricted RN license with diversified nursing experience
• At least 5+ years of relevant experience in a provider or payer environment
• Experience in health care claims, including ICD-9/ICD-10 coding
• Strong technical aptitude with intermediate to advanced Excel skills
• Experience in utilization review for an insurance company is preferred