MedReview is hiring a
Nurse Auditor

Summary

The job is for a registered nurse with auditing experience to perform bill review and chart validation at MedReview's Hospital Bill Review Department. The position offers benefits such as healthcare, 401(k) with employer match, generous paid time off, wellness programs, learning & development opportunities, and family & parental leave.

Requirements

• Must be a registered nurse with active RN license
• BSN or equivalent required
• 2-5 years in either Medical Surgical or Critical Care experience required
• Ability to use Windows PC with the ability to utilize multiple applications at the same time
• Knowledge of appeals preferred
• Knowledge of CMS guidelines preferred

Responsibilities

• Must be detail oriented and highly organized
• Solid understanding of anatomy and physiology, diagnostic and surgical procedures
• Demonstrates the ability to accurately interpret what is transcribed in the medical record
• Writes clear, accurate and concise clinical notes in support of findings
• Maintains and manages case reviews with a high emphasis on quality
• Demonstrates the ability to work in a high – volume production environment
• Knowledge of health insurance business, industry terminology, and regulatory guidelines
• Accurately interprets Plan policies and appropriately applies to the clinical audit
• Ability to communicate effectively both orally and in writing
• Complete appeal reviews when needed
• Demonstrates the ability to perform a level of care review utilizing Interqual guidelines
• Maintain and update hospital profiles as needed

Preferred Qualifications

• 2-5 years auditing experience preferred, however will also consider Utilization Review, Managed Care, Case Management experience
• Excellent computer skills

Benefits

• Healthcare that fits your needs
• 401(k) with Employer Match
• Generous Paid Time Off
• Wellness programs
• Learning & Development opportunities
• Family and parental leave