RN Licensed Nurse Specialist II

Job Summary

A company is looking for a Nurse Specialist II, Audit.

Key Responsibilities

• Review medical record documentation to verify clinical indicators and coding issues related to various audits
• Create detailed appeal letters for denials from payers to support payment of patient claims
• Identify root causes and trends to share with clients and staff, while providing feedback for ongoing training

Required Qualifications

• Current and valid RN License
• Minimum of two years of experience in an acute care hospital
• Minimum of five years of experience in clinical medical record audits or coding
• Experience using InterQual and Milliman healthcare criteria preferred
• Knowledge of CMS and payer reimbursement guidelines preferred