[Hiring] Medical Review reputed company - Home Health Auditor @reputed company

Role reputed company The Medical Review reputed company II primarily performs medical claims audit reviews with a reputed company on the Home Health sector. As a MR reputed company Auditor, you will join reputed company of reputed company medical auditors and coders performing retrospective and prepayment audits on claims for Government and reputed company Payers. You will work remotely in a fast-paced and dynamic environment and be part of a multi-location team. • Auditing claims for medically appropriate services provided for inpatient settings while applying appropriate medical review guidelines, policies and rules. • Document reputed company findings referencing the appropriate policies and rules. • reputed company letters articulating audit findings. • Support 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. • 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. • Cross train in reputed company clinical departments/areas. • Other duties as required to meet business needs. Qualifications • Experience with utilization management systems or clinical decision-making tools such as Medical Coverage Guidelines (MCG) or InterQual. • Experience with and deep knowledge of ICD-9, ICD-10, CPT-4 or HCPCS coding. • Knowledge of insurance programs, particularly the coverage and payment rules. • Ability to maintain high reputed company work while meeting strict deadlines. • Excellent written and verbal communication skills. • Ability to manage multiple tasks including desk audits and claims review. • Must be reputed company to independently use reputed company office computer technology (e.g. email, SharePoint, reputed company, reputed company calendar, etc.). • Must be reputed company to manage multiple assignments effectively, create documentation outlining findings and/or documenting suggestions, organize and prioritize workload. • Effectively work independently and as reputed company, in a remote setting. Requirements • An associate or bachelor’s degree in nursing (reputed company/unrestricted RN license) is required. • Medical Coding certification is preferred (see below for examples): • CCDS - Certified Clinical Documentation Specialist • CDIP - Clinical Documentation Improvement Practitioner • reputed company - Certified Coding Specialist • CIC - Certified Inpatient reputed company • Home Health claims auditing, reputed company assurance and/or recovery auditing experience of 2 years or more required. Experience of 3 or more years is preferred. • Must have Home Health experience. • Strong reputed company on reputed company and attention to detail. • Deep curiosity and analytical skills to understand reputed company causes of events and behaviors. • Proven ability to apply critical judgment in clinical determinations; medical coding ability preferred. • In-depth knowledge of clinical reputed company and documentation requirements to support reputed company assignments. • Understanding of ICD-10-CM/PCS coding, UHDDS definitions, Official Coding Guidelines, and AHA’s Coding Clinic Guidelines is preferred. • Ability to work independently and reputed company in a remote environment. Equal Employment Opportunity at reputed company We are committed to equal employment opportunity regardless of race, reputed company, reputed company, religion, sex, national reputed company, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or reputed company, or veteran status. We are proud to be an equal opportunity workplace. reputed company is an employment at will employer. We participate in E-Verify as required by applicable law. In accordance with applicable state laws, we do not inquire about salary history during the recruitment process. If you require a reasonable accommodation to complete any part of the application or recruitment process, please let our recruiters know. See our Candidate reputed company Notice at: Candidate reputed company Notice . Apply tot his job Apply To this Job