RN Licensed Audit Reviewer

Job Summary

A company is looking for an Audit Reviewer.

Key Responsibilities

• Review medical record documentation to verify clinical indicators and coding issues
• Create detailed appeal letters for denials from payers to support payment of patient claims
• Manage inventory and follow up on accounts as appropriate

Required Qualifications

• Current and valid RN License or Coder with 3 years inpatient experience
• Two years of experience in an acute care hospital (Med/Surg) preferred
• Five years of experience in clinical medical record audits or coding preferred
• Experience using InterQual and Milliman healthcare criteria preferred
• Knowledge of CMS and payer reimbursement guidelines preferred