Clinical Denials Auditor

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Support the Utilization and Denials management team in generating daily operational reports.

• Offer quality assurance (QA) feedback for specialists in Utilization and Denials Management.

• Track performance through key metrics related to Utilization Management and Clinical Denials & Appeals.

• Relay progress updates to the Manager across the team.

• Guide staff to enhance their performance and unlock their potential.

• Facilitate monthly team meetings and conduct annual performance evaluations.

• Collaborate with global Operations, Training, and HR to optimize onboarding and on-the-job learning (OJL).

⛳️ Requirements

• A minimum of 1 year of experience in Utilization management and/or Clinical appeals writing QA or auditing within a healthcare environment.

• At least 3-5 years of clinical experience in an acute care hospital setting (preferably Med/Surg); 2-3 years of experience in ICU.

• An Associate Degree in Nursing (ADN) or a Nursing Diploma is required.

• Must be a Registered Nurse with an active U.S. Registered Nurse (USRN) license.

• Skilled in utilizing InterQual or MCG clinical guidelines.

• Comprehensive knowledge of U.S. Government Programs and Insurance Regulations.

• Familiarity with hospital-based electronic medical records (EMR) systems such as Epic, Cerner, or Meditech.

🏝️ Benefits

• Medical coverage

• Dental coverage

• Vision coverage

• 401(k) plan with employer matching

• Paid Time Off policy

• Paid parental leave

• Adoption assistance

• Complimentary annual health screenings

• Coaching and wellness programs