Clinical Auditor, RN

📋 Description

• Assist with reviews of medical records and billing compliance audits for the Indiana Health Coverage Programs.

• Assess the quality of care by examining medical records and program policies, while identifying compliance concerns.

• Create audit documentation and reports, and aid in the appeals process.

• Perform independent medical record and compliance reviews, providing initial findings to the Lead Reviewer.

• Detect potential deficiencies in documentation and issues related to billing compliance.

• Keep thorough workpapers that detail the procedures conducted, records examined, findings discovered, and conclusions drawn.

• Support audit responses and appeals as necessary.

• Ensure that all work is consistent with state, federal, and national healthcare and Medicaid regulations.

⛳️ Requirements

• RN license is preferred; Indiana license or compact license is accepted.

• Coding certification such as CCS or CPC is highly preferred.

• A minimum of 1 year of experience in Medicaid claims review, billing compliance, or healthcare reimbursement is required.

• Familiarity with Indiana Medicaid policies, payer guidelines, and documentation standards is preferred.

• Knowledge of CPT coding guidelines and ICD-10 standards is necessary.

• Proficiency in Microsoft Excel, Word, and Outlook is essential.

• Strong analytical, critical thinking, problem-solving, and technical writing abilities are required.

• Capability to work both independently and collaboratively in a dynamic environment is essential.

• Experience collaborating with healthcare providers is strongly preferred.

• Understanding of healthcare claims data and issues related to fraud, waste, and abuse is preferred.

🏝️ Benefits

• Solutions arise from innovative ideas; innovation stems from embracing diversity.

• Briljent values diversity and inclusion as vital to the company’s success.

• We uphold a non-discrimination policy for all employees and applicants, regardless of race, creed, color, religion, gender, sexual orientation, national origin, disability, age, veteran status, marital status, or any other status protected by federal, state, or local laws, regulations, or ordinances.