RN Clinical Auditor

Job Summary

A company is looking for a RN-Clinical Auditor 2.

Key Responsibilities

• Performs audits of medical records for denials review, defense audits, disallowed charges, and utilization reviews
• Completes analysis of records against established criteria to determine compliance with patient care standards
• Organizes and prioritizes multiple cases while maintaining confidentiality and adhering to HIPAA guidelines

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 case management, Medicare appeals, or denials management
• Knowledge of Milliman (MCG) or InterQual criteria preferred
• Experience in medical records review, claims processing, or utilization/case management
• Proficiency in Microsoft Outlook, Word, Excel, and electronic documentation systems