RN, Clinical Auditor
Savista
full-time
Posted on:
Location Type: Remote
Location: United States
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Salary
💰 $28 - $38 per hour
About the role
- The Clinical Auditor 2 performs audits of medical records on behalf of hospital clients for denials review, defense audits, disallowed charges, and utilization reviews.
- This position requires critical thinking and judgment and must demonstrate the ability to appropriately use standard criteria such as InterQual and Milliman (MCG) in addition to criteria established by state Medicaid programs or hospital policy.
- Audit and analysis must be accurate and consistently ensure a high level of quality, knowledge of laws, rules, regulations and guidelines necessary to ensure compliance and protection of information.
- Performs audits of medical records to identify and/or defend charges, including Defense Audits, Patient Inquiry Audits, Disallowed Charges, and Biller Requested Audits.
- Completes analysis of records against established criteria to determine if patient condition and/or care meets that criteria, including Avoidable day studies, Managed care, Medicare or Medicaid reconsiderations/appeals, Medicare or Medicaid RAC appeals or other specialized Audit Appeals.
- Determine, request, and obtain appropriate supporting documentation from hospital, physicians, current medical literature and patient.
- Will compose appeal letters addressing and appealing both contract issues and medically related issues.
- Organizes and prioritizes multiple cases concurrently to ensure departmental workflow and case resolution.
- Enter audit findings and/or data into Client’s computer based system.
- Proficiently utilize multiple computer based systems to complete and document work (both Savista and client).
Requirements
- Must be RN/Case Management /Utilization Review/Coding clinical certification with a BS/BA preferred otherwise equivalent years of technical experience
- 3 to 5 years of clinical experience or 3 to 5 years of clinical auditing experience in either case management, Medicare appeals, utilization review or denials management
- Knowledge of Milliman (MCG) or InterQual criteria preferred
- Experience in medical records review, claims processing or utilization/case management in a clinical practice or managed care organization
- Fundamental knowledge of Medicare/Medicaid Guidelines
- Proficiency in navigating the internet and multi-tasking with multiple electronic documentation systems simultaneously (toggling)
- Skilled with Microsoft Outlook, Word, Excel and EMR Savista is required by state specific laws to include the salary range for this role when hiring a resident in applicable locations.
Benefits
- Competitive salary
- Professional development opportunities
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
clinical auditingmedical records reviewclaims processingutilization reviewdenials managementcritical thinkinganalysisdocumentationappeal letter compositionknowledge of Medicare/Medicaid guidelines
Soft skills
judgmentorganizational skillsprioritizationmulti-taskingcommunication
Certifications
RNCase Management certificationUtilization Review certificationCoding clinical certification