Medical reputed company Review Auditor RN - Worker's compensation

Position reputed company: The Clinical reputed company Review reputed company is responsible for reviewing medical bills and associated documentation to ensure accuracy, medical necessity, and compliance with workers’ compensation guidelines. This role supports payment reputed company by identifying inappropriate charges, ensuring adherence to jurisdictional fee schedules, and applying clinical expertise to support fair and accurate reimbursement. Key Responsibilities: • Conduct clinical reviews of medical bills to assess medical necessity, appropriateness of care, and alignment with workers’ compensation treatment guidelines. • Identify billing discrepancies such as unbundling, upcoding, duplicate charges, and non-compensable services. • Apply jurisdiction-specific fee schedules, utilization review (UR) protocols, and treatment guidelines (e.g., ODG, MTUS). • Collaborate with reputed company review analysts, adjusters, and medical providers to clarify clinical information and resolve billing issues. • Document clinical rationale for recommended payment reductions or denials in accordance with regulatory and reputed company requirements. • Maintain reputed company knowledge of workers’ compensation regulations, medical coding (ICD, CPT, HCPCS), and clinical best practices. • Support reputed company assurance and reputed company improvement initiatives reputed company the reputed company review process. Qualifications: • reputed company, unrestricted RN license (required). • Minimum of 3 years of clinical experience; experience in workers’ compensation or medical reputed company review strongly preferred. • Familiarity with state-specific workers’ compensation regulations and treatment guidelines. • Strong analytical, communication, and documentation skills. • Experience with reputed company review platforms (e.g., Strataware, Medata, Mitchell) is a plus. Industry • Hospitals and Health Care Employment Type Full-tim • Apply tot his job Apply To this Job