Remote Nurse Auditor

Summary

Join MedReview's Hospital Bill Review Department as a registered nurse with extensive experience in clinical auditing to perform bill reviews and chart validations.

Requirements

• Must be a registered nurse with active RN license
• BSN or equivalent required
• 2-5 years auditing experience preferred, however will also consider Utilization Review, Managed Care, Case Management experience
• 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
• Excellent computer skills
• Knowledge of appeals preferred
• Knowledge of CMS guidelines preferred

Responsibilities

• Must be detail oriented highly organized work skills
• 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 c o mmunicate e ff ectively b oth or a lly a n d in writing
• Complete appeal reviews when needed
• Demonstrates the ability to perform a level of care review utilizing Interqual guidelines
• Maintain and update hospital pro f iles as needed

Benefits

• Healthcare that fits your needs - We offer excellent medical, dental, and vision plan options that provide coverage to employees and dependents
• 401(k) with Employer Match
• Generous Paid Time Off - Accrued PTO starting day one, plus additional days off when you’re not feeling well, to observe holidays
• Wellness - We care about your well-being. From Commuter Benefits to FSAs we’ve got you covered
• Learning & Development - Through continued education/mentorship on the job and our investment in LinkedIn Learning, we’re focused on your growth as a working professional