RN Clinical Auditor
Ensemble Health Partners
full-time
Posted on:
Location Type: Remote
Location: United States
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Salary
💰 $63,100 - $108,900 per year
About the role
- Perform complete government, state, and commercial payer clinical audit reviews
- Analyze and review clinical audit and DRG clinical validation audits
- Gather appropriate medical records from client EMR per government requirements
- Contact regulatory bodies to determine the reason for the audit
- Review audit letters and analyze claims
- Prepare audit materials and respond to requests for additional documentation
- Collaborate with healthcare providers and educate staff on best practices and audit outcomes
- Participate in the development of clinical guidelines and protocols
Requirements
- 2+ years of regulatory audit experience, utilization review, clinical validation, denials or case management experience strongly preferred
- Experience in hospital operations, chart audit/review, and clinical education
- Ability to manage time, meet audit deadlines, and handle multiple tasks.
- Experience working in a production-based work environment
- Flexibility to adapt to changing regulations, work multiple assigned audit tasks and healthcare environments.
- Ability to work independently and manage workload.
- Ability to evaluate complex situations and make informed decisions.
- Familiarity with electronic medical records (EMR) systems.
- Experience using multiple software programs and tools.
- Must be inquisitive and demonstrate openness to innovation including AI to explore better processes and ways to alleviate friction and improve patient and client experiences.
Benefits
- Bonus Incentives
- Paid Certifications
- Tuition Reimbursement
- Comprehensive Benefits
- Career Advancement
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
regulatory auditutilization reviewclinical validationdenials managementcase managementchart auditclinical educationmedical record analysisaudit preparationclinical guidelines development
Soft Skills
time managementmultitaskingflexibilityindependent workdecision makinginquisitivenessopenness to innovationcollaborationcommunicationeducational skills