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Nurse Auditor I
Trend Health PartnersNurse Auditor I at TREND Health Partners performing medical necessity reviews of clinical documentation. Ensuring compliance with policy, procedures, and guidelines while maintaining a high success rate in appeals.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in auditing clinical documentation and applying clinical guidelines to ensure compliance with payer policies. Strong communication and organizational skills are essential for developing relationships with medical providers and health plans.
Highest-signal resume keywords
Active RN Or LPN License5 Years Of Clinical PracticeClinical Documentation AuditingVerbal And Written Communication SkillsTask Prioritization
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
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Hard Skills
Clinical Documentation AuditingApplication Of Clinical GuidelinesKnowledge Of Payer PoliciesMedical Necessity AssessmentProcess Improvement
Soft Skills
Verbal CommunicationWritten CommunicationOrganizationRelationship BuildingPrioritization
Certifications & Qualifications
Active RN Or LPN License
Industry Keywords
Clinical PracticeRegulatory IssuesContinuum Of CareHealthcare GuidelinesOngoing Training
About the role
Key responsibilities & impact- Independently audit clinical documentation to ensure consistent with billed services in a production environment
- Apply clinical and industry guidelines, payer P&P, and use of in-depth knowledge that supports medically necessity of services rendered
- Develop relationships with medical providers and health plans to confirm adherence to P&P, guidelines, and continuum of care.
- Continually keep abreast of technology changes, regulatory issues, and medical practice through ongoing training and self-directed research and share with others, accordingly
- Share ideas that offer process improvements and share with team for education.
Requirements
What you’ll need- An active RN or LPN professional license in good standing
- 5 years of clinical practice
- Well-developed verbal and written communication skills coupled with recognizable organization
- Ability to effectively prioritize tasks
Benefits
Comp & perks- competitive salaries
- highly valued health insurance
- a 401(k) plan with employer match
- paid parental leave