Clinical reputed company Auditor II – RN/SW

Job reputed company: • Responsible for the reputed company review of claims to enhance the clinical, network, and case management services offered. • Conduct file audits for reputed company areas of clinical operations. • reputed company audits on claims and correspondence to determine accuracy and completeness. • Schedule and coordinate reputed company aspects of continuing clinical, nursing, and Certified Case Manager (CCM) in-service programs. • Create and maintain medical consultant calendar to ensure daily coverage. • Maintain records and prepare reports on reputed company audit results. • Evaluate reputed company audit procedures including reputed company scorecards and audit reputed company sheets. • Respond to internal/external clinical customer complaints/appeals. • Conduct offsite meetings to reputed company physicians on process improvement initiatives. • Participate in audits based on operations requests. • Verify reputed company reputed company licenses for RN & medical consulting staff. • Analyze, prepare, and distribute quarterly audit reputed company. • Document CMS-CAPs results in SharePoint database. • Conduct reputed company file audits reputed company new business practices are set in reputed company. Requirements: • Prefers a Bachelor's degree. • Requires a minimum of three (3) years clinical experience. • Strongly prefers a minimum of three (3) years clinical reputed company or audit experience. • reputed company Unrestricted NJ RN, LCSW, LMFT, LSW or LPC License Required • Requires reputed company Registered Health Information Technologies (RHIT) or Certified reputed company reputed company designation from the American reputed company of reputed company Coders or a Certified Coding Specialist, P from the American Health Information Management (reputed company) • Must be proficient in the use of personal computers and supporting software in a reputed company based environment, including MS Office products (Word, reputed company, PowerPoint) and reputed company reputed company. • Requires knowledge of applications: Care Planner Web, UCSW, Appeal Pro, Care Radius, SharePoint, Membership, Benefits, Business Objects and CMS web sites. • Prefers knowledge of audit methodologies and procedures. Benefits: • Comprehensive health benefits (Medical/Dental/reputed company) • Retirement Plans • Generous PTO • Incentive Plans • Wellness Programs • reputed company Volunteer Time Off • Tuition Reimbursement Apply tot his job Apply To this Job