RN Medical Review Auditor
Job Summary
To support healthcare audit processes, the remote RN Medical Review Auditor will conduct clinical reviews and Appeals reviews of medical records, ensuring compliance with quality standards while serving as a subject matter expert in the field.
Key Responsibilities
- Conducts clinical reviews and Appeals reviews on medical audit findings, documenting results accurately
- Analyzes claims data and applies knowledge of relevant guidelines and regulations to validate audit results
- Identifies training opportunities and contributes to continuous improvement initiatives within the audit process
Required Qualifications
- Active unrestricted RN license in good standing with diversified nursing experience
- At least 5+ years of relevant SNF/MDS experience in a provider or payer environment
- Strong technical aptitude with intermediate to advanced Excel skills
- Experience with ICD-9/ICD-10 coding, HCPS/CPT coding, and medical billing
- Prior experience in audit, utilization management, or appeals functions
Complete Job Description
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