RN Clinical Audit Analyst

Job Summary

A company is looking for a RN Clinical Audit Management Analyst.

Key Responsibilities

• Oversee and coordinate payer audit requests, progress, case determinations, appeals, and resolutions
• Consult with internal experts on complex cases and manage the appeal process
• Maintain knowledge of compliance regulations and reimbursement models related to Medicare and Medicaid

Required Qualifications, Training, and Education

• Bachelor's Degree in a health-related field or six years of equivalent work experience
• Registered Nurse (RN) license preferred; coding certification is also preferred
• Must hold an unencumbered RN license in the applicable state or possess multistate licensure if in a Nurse Licensure Compact (NLC) state
• Must obtain and maintain required department-specific competencies and certifications