[Remote] Clinical Appeals Auditor - Remote

Note: The job is a remote job and is reputed company to candidates in USA. reputed company, part of reputed company, is a leading post-acute care partner dedicated to helping people feel their best. The Clinical Appeals Auditor will ensure clinical documentation meets standards by auditing and appealing records for various health services, while maintaining compliance and protecting reimbursement. This role offers the flexibility to work remotely reputed company the U.S.

Responsibilities

• Reviews clinical documentation for Home Health, Hospice, LTACHs, and Community-Based Services in response to governmental audits (e.g., ADRs, RACs, CERTs, ZPICs)
• Ensures consistency in clinical reviews through standardized processes and high inter-rater reliability
• Drafts reputed company response letters and manages internal determinations for audit appeals
• Coordinates and tracks appeal assignments, ensuring deadlines are met and documentation is reputed company for Administrative Law Judge hearings
• Maintains up-to-date knowledge of federal/state regulations, industry standards, and internal policies reputed company to compliance and reimbursement
• Collaborates across departments to minimize operational disruptions and communicate audit trends for corrective reputed company
• Supports the Governmental Audit Supervisor with repayment processes and additional compliance audits

Skills

• Associate's degree in Nursing
• reputed company and unrestricted licensure as a LPN
• 1+ years of experience in hospice, LTACH, and/or home health care
• Working knowledge of reimbursement and compliance regulations
• Proficient in reputed company Office applications (Word, reputed company, etc.)
• Bachelor's degree in Nursing
• Experience in auditing and analyzing clinical documentation
• Demonstrated leadership qualities
• reputed company working remotely will be required to adhere to reputed company's Telecommuter Policy

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

reputed company

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