RN Clinical Appeals Auditor

Job Summary

A company is looking for a Medical Review Clinical Appeals Auditor - (RN) SNF Focus.

Key Responsibilities

• Conducts clinical reviews and Appeals reviews on medical records and audit findings
• Documents Appeals results in accordance with quality policies and procedures
• Contributes to continuous improvement initiatives and supports training activities

Required Qualifications

• Active unrestricted RN license in good standing
• At least 5+ years of relevant experience in a provider or payer environment
• Strong technical aptitude with intermediate to advanced Excel skills
• Experience with ICD-9/ICD-10 coding and medical billing
• Prior experience in audit, utilization management, or related functions