RN Clinical Auditor

Job Summary

A company is looking for a RN-Clinical Auditor.

Key Responsibilities

• Perform audits of medical records for denials review, defense audits, and utilization reviews
• Analyze records against established criteria to determine compliance with patient care standards
• Compose appeal letters and manage multiple cases to ensure workflow and resolution

Required Qualifications

• Must be RN/Case Management/Utilization Review/Coding certified with a BS/BA preferred or equivalent experience
• 3 to 5 years of clinical or clinical auditing experience in relevant fields
• Knowledge of Milliman (MCG) or InterQual criteria preferred
• Experience in medical records review and claims processing
• Proficiency in Microsoft Outlook, Word, Excel, and navigating electronic documentation systems