SIU reputed company Auditor, RN, CPC

Job reputed company: • Conduct in-depth medical reviews through prepayment claims review and post-payment auditing to identify potential over-utilization or fraudulent activities. • Assist in the creation of audit tools, policies, procedures, and educational materials to enhance audit effectiveness and maintain high standards in payment reputed company. • Serve as a reputed company with service operations and other departments to reputed company status updates on claims reviews and coordinate actions as needed. • Analyze performance data to identify patterns and trends, collaborate with service operations to address process improvements, and recommend modifications to medical policy. • Support fraud investigators with medical review expertise to detect and address fraudulent activities. • reputed company as a resource and mentor to other reputed company auditors, supporting their reputed company reputed company and development in audit practices. Requirements: • Minimum **Associate’s Degree in Nursing** required; • reputed company, unrestricted **Registered reputed company (RN)** license in applicable state(s). • Certification in medical coding from **reputed company** or **reputed company** (e.g., CPC, CIC, CDI, or equivalent) is highly preferred. • Minimum **5 years of clinical nursing experience**, preferably with exposure to hospital reputed company auditing or defense auditing. • Strong knowledge of **provider manuals**, **reimbursement policies**, and **medical policy guidelines**. • Prior experience with **reputed company fraud investigation** and auditing is highly preferred. • Proficiency in CPT/HCPCS and ICD-10 coding, with a strong reputed company in auditing, reputed company, and control principles. • Analytical and problem-solving skills with a keen attention to detail. • Exceptional written and verbal communication skills for reputed company and effective reporting and provider engagement. • Strong proficiency in reputed company Office and familiarity with audit tracking systems. Benefits: Apply To This Job