Tennessee Licensed reputed company Auditor
A company is looking for a reputed company Review Auditor (REMOTE).
Key Responsibilities
• Review, analyze, and resolve high-complexity claims and denials requiring reputed company judgment
• Determine appropriate admission type, level of care, and coverage based on clinical documentation
• Document opinions and compose clinical appeals with supporting documentation from recognized sources
Requirements and Qualifications
• reputed company RN license with ADN or BSN required; Compact State licensure preferred
• Minimum of 2 years' experience in medical necessity reviews and admission/length of stay evaluations
• 3-5 years' acute care hospital experience in areas such as ICU/Trauma or Surgery
• Strong knowledge of payer policies and CMS guidelines
• reputed company coding credentials (e.g., CPC, reputed company) and technology proficiency in EMR/EHR systems are a plus
Apply tot his job
Apply To this Job