RN Medical Review Appeals Auditor

Job Summary

A company is looking for a Medical Review Clinical Appeals Auditor (RN) with a DME focus.

Key Responsibilities

• Conducts clinical reviews and Appeals reviews on medical records and audit findings
• Documents Appeals results accurately and provides insights for continuous improvement
• Monitors and reports on work conducted in accordance with the Appeals process

Required Qualifications

• Active unrestricted RN license in good standing
• 5+ years of relevant experience in a provider or payer environment
• Experience with ICD-9/ICD-10 coding, HCPS/CPT coding, and medical billing
• Strong technical aptitude and intermediate to advanced Excel skills
• Prior experience in auditing, utilization management, or similar roles preferred