RN – Clinical Auditor 2
Savista
full-time
Posted on:
Location Type: Remote
Location: United States
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Salary
💰 $28 - $38 per hour
About the role
- Perform audits of medical records for denials review, defense audits, disallowed charges, and utilization reviews
- Complete analysis of records against established criteria
- Determine, request, and obtain appropriate supporting documentation
- Compose appeal letters addressing both contract issues and medically related issues
- Organize and prioritize multiple cases for departmental workflow
- Enter audit findings into computer systems
- Function in a professional manner focusing on customer service
Requirements
- RN/Case Management/Utilization Review/Coding clinical certification
- 3 to 5 years of clinical experience or auditing experience
- 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 electronic documentation systems
- Skilled with Microsoft Outlook, Word, Excel, and EMR Savista
Benefits
- Health insurance
- Professional development opportunities
- 401(k) retirement plan
- Remote work options
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
auditingmedical records reviewclaims processingutilization reviewcase managementdocumentation analysisappeal letter compositionMedicare guidelinesMedicaid guidelinesMilliman criteria
Soft Skills
customer serviceorganizationprioritizationprofessionalismmulti-tasking
Certifications
RN certificationCase Management certificationUtilization Review certificationCoding clinical certification