Audit Reviewer, RN/CPC

This is a fully remote position, open to applicants in Alabama, +18 more states.

📋 Description

• Evaluates medical record documentation to confirm clinical indicators and coding concerns relevant to DRG Validation Audits, Emergency Department Downgrade Audits, Inpatient Level of Care Audits, and Charge Outlier Audits, among others.

• Drafts comprehensive appeal letters for payer denials to support the payment of patient claims.

• Oversees inventory management and follows up on accounts as necessary.

• Analyzes InterQual/Milliman criteria, coding standards, and/or payer medical policies concerning denied procedures or services, incorporating relevant criteria in appeal letters as needed.

• Provides constructive feedback to management on issues identified to facilitate ongoing training for colleagues and non-clinical staff.

• Detects root causes and trends to communicate with clients and staff.

• Collaborates with colleagues on clinical writing tasks.

⛳️ Requirements

• Must possess a current and valid RN License or be a Coder with a minimum of 3 years of inpatient experience.

• Preferred: Two years of experience in an acute care hospital setting (Med/Surg).

• Preferred: Five years of experience in clinical medical record audits or coding.

• Preferred: Familiarity with InterQual and Milliman healthcare criteria.

• Preferred: Experience in reviewing CMS LCD/NCD criteria.

• Preferred: Understanding of CMS and payer reimbursement guidelines.

• Preferred: Knowledge of DRG, ICD-10, CPT, and HCPCS coding.

• Must be comfortable meeting productivity standards.

🏝️ Benefits

• Medical

• Dental

• Vision

• Life insurance

• Short term disability

• Long term disability

• Bonus opportunities

• Paid holidays

• 401k

• Generous PTO policy