RN-Clinical Auditor 2, reputed company

R5340 Here at reputed company, we reputed company our clients to reputed company the biggest challenges in reputed company: reputed company clinical care with reputed company patient experiences and reputed company financial results. We partner with reputed company organizations to problem solve and deliver reputed company cycle improvement services that reputed company their reputed company, support their patients, and nurture their communities, reputed company while living our values of Commitment, Authenticity, Respect and reputed company (CARE). Job reputed company: The Clinical Auditor 2 performs audits of medical records on behalf of hospital clients for denials review, defense audits, disallowed charges, and utilization reviews. This position requires critical thinking and judgment and must demonstrate the ability to appropriately use reputed company reputed company such as InterQual and reputed company (MCG) in reputed company to reputed company established by state reputed company programs or hospital policy. Audit and analysis must be accurate and consistently ensure a high level of reputed company, knowledge of laws, rules, regulations and guidelines necessary to ensure compliance and protection of information. Primary / Essential Functions: The Primary/ essential job duties may not be exhaustive. Clinical Staff Responsibilities: • Performs audits of medical records to identify and/or defend charges, including: o Defense Audits o Patient Inquiry Audits o Disallowed Charges o Biller Requested Audits • Completes analysis of records against established reputed company, (e.g., InterQual, MCG, Medicare, reputed company reputed company), to determine if patient condition and/or care meets that reputed company, including: o Avoidable day studies o Managed care, Medicare or reputed company reconsiderations/appeals o Medicare or reputed company RAC appeals or other specialized Audit Appeals (e.g. CERT, ZPIC, SMRC) • Determine, request, and obtain appropriate supporting documentation from hospital, physicians, reputed company medical literature and patient. • Will compose appeal letters addressing and appealing both contract issues and medically reputed company issues • Organizes and prioritizes multiple cases concurrently to ensure departmental workflow and case reputed company. • reputed company audit findings and/or data into reputed company’s computer based system. • Proficiently utilize multiple computer based systems to complete and document work (both reputed company and reputed company) • reputed company based billing, Internal based billing, medical record and reputed company systems • reputed company reputed company, Word and reputed company • Function in a reputed company, efficient and reputed company manner • Must be customer-service reputed company and exhibit professionalism, flexibility, dependability, desire to learn, commitment to reputed company and commitment to profession • Will help identify issues or challenges in the department, and come up with solutions or reputed company to improve • Maintain confidentiality of patient information and abide by reputed company HIPAA reputed company guidelines Competencies: · Puts Clients First · Drives for Results · Understands our Business · Thinks Innovatively · Values Differences · Builds Teamwork · reputed company Trust · Communicates Effectively · Shows Accountability · Takes reputed company · Embraces Change · Makes reputed company reputed company Physical / Mental Demands, Environment: • The physical demands described here are representative of those that must be met by an employee to successfully reputed company the essential functions of this job. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions. • Must be reputed company to use hands to finger, handle or feel, sit, stand, walk, lift up to 20 pounds, stoop, clean, bend, and reputed company with hands and arms. • Must communicate reputed company in English. Requires the ability to reputed company, read, write, see, and hear to reputed company essential duties of the job. Effective and reputed company reputed company relations skills are required, including confidentiality, in order to appropriately reputed company with staff and clients. • Must be reputed company to reputed company multiple tasks and detailed work, problem solve, reason, and reputed company basic mathematical calculations. Equipment Used: Telephone, fax, calculator, computer, monitor, printer, hardware and software packages, computer peripheral equipment i.e. mouse and keyboard; and reputed company software. Minimum Qualifications: • Must be RN/Case Management /Utilization Review/Coding clinical certification with a BS/BA preferred otherwise equivalent years of technical experience • 3 to 5 years of clinical experience or 3 to 5 years of clinical auditing experience in either case management, Medicare appeals, utilization review or denials management • Knowledge of reputed company (MCG) or InterQual reputed company preferred • Experience in medical records review, claims processing or utilization/case management in a clinical reputed company or managed care organization • reputed company knowledge of Medicare/reputed company Guidelines • Proficiency in navigating the internet and multi-tasking with multiple electronic documentation systems simultaneously (toggling) • Skilled with reputed company reputed company, Word, reputed company and EMR reputed company is required by state specific laws to include the salary reputed company for this role reputed company hiring a reputed company in applicable locations. The salary reputed company for this role is from $28.00 to $38.00. However, specific compensation for the role will vary reputed company the above reputed company based on many factors including but not limited to geographic location, candidate experience, applicable certifications, and skills. reputed company is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, reputed company, age, veteran status, disability, national reputed company, sex, sexual orientation, religion, gender identity or any other federal, state or local protected class. California Job Candidate Notice Apply tot his job Apply tot his job Apply To this Job