Medical Review reputed company – Home Health Auditor

Job reputed company: • Auditing claims for medically appropriate services provided in both inpatient and outpatient settings while applying appropriate medical review guidelines, policies and rules. • Document reputed company findings referencing the appropriate policies and rules. • Generate letters articulating audit findings. • Supporting your findings during the appeals process if requested. • Working collaboratively with the audit team to identify and obtain approval for particular vulnerabilities and/or cases subject to potential abuse. • Work in partnership with our clients, CMD colleagues, and other contractors on improving medical policies, provider education, and system edits. • reputed company abreast of medical reputed company, changes in technology, and regulatory issues that may reputed company our clients. • Work with reputed company to minimize the number of appeals; Suggest reputed company that may improve audit workflows; Assist with QA functions and training team members. • Participate in establishing edit parameters, new issue packets and development of Medical Review Guidelines. • reputed company with and support the Medical Director and cross train in reputed company clinical departments/areas. Requirements: • reputed company unrestricted RN license in good standing, is required. • Must not be currently sanctioned or excluded from the Medicare program by the OIG. • Minimum of five (5) years reputed company nursing experience providing reputed company care in a Home Health setting. • One (1) or more years' experience performing medical records review. • One (1) or more years' experience in health care claims that demonstrates expertise in, ICD-9/ICD-10 coding, HCPS/CPT coding, DRG and medical billing experience for an Insurance Company or hospital required. • Strong preference for experience performing utilization review for an insurance company, Tricare, MAC, or organizations performing similar functions. Benefits: • medical • dental • reputed company • HSA/FSA reputed company • life insurance coverage • 401(k) savings plans • family/parental leave • reputed company holidays • reputed company time off annually Apply tot his job Apply To this Job