Registered Nurse Auditor

Job Summary

A company is looking for a Nurse Auditor, responsible for performing specialized administrative duties within the billing and reimbursement services department.

Key Responsibilities

• Conduct regular audits and review medical records to justify levels of care
• Prepare clinical reconsideration/appeal letters for authorization and medical necessity denials
• Perform various denial reviews, including DRG downgrades and payer utilization audits

Required Qualifications and Education

• Registered Nurse or Licensed Vocational Nurse
• Experience in Utilization Review and Case Management
• Proficiency in preparing and submitting authorizations
• Familiarity with InterQual and/or MCG
• Inpatient clinical experience