Job Summary
A company is looking for a Clinical Auditor 2.
Key Responsibilities
- Performs audits of medical records for denials review, defense audits, disallowed charges, and utilization reviews
- Completes analysis of records against established criteria to determine compliance with patient condition and care standards
- Organizes and prioritizes multiple cases, enters audit findings into the client's computer system, and composes appeal letters
Required Qualifications
- RN/Case Management/Utilization Review/Coding or clinical certification with a BS/BA preferred, or equivalent technical experience
- 3 to 5 years of clinical or clinical auditing experience in case management, Medicare appeals, or denials management
- Knowledge of Milliman (MCG) or InterQual criteria preferred
- Experience in medical records review, claims processing, or utilization/case management
- Proficiency in Microsoft Outlook, Word, Excel, and navigating electronic documentation systems
Comments