RN Nurse Specialist II

Job Summary

A company is looking for a Nurse Specialist II, Audit.

Key Responsibilities

• Review medical record documentation for clinical indicators and coding issues related to various audits
• Create detailed appeal letters for payer denials to support patient claims
• Identify root causes and trends to share with clients and staff, providing feedback for ongoing training

Required Qualifications, Training, and Education

• Current and valid RN License
• Minimum of two years of experience in an acute care hospital
• Minimum of five years of experience in clinical medical record audits or coding preferred
• Experience using InterQual and Milliman healthcare criteria preferred
• Knowledge of CMS and payer reimbursement guidelines preferred