At our organization, our mission is to bring accuracy, accountability, and clinical excellence to healthcare. We specialize in payment integrity solutions, including DRG Validation, Cost Outlier, and Readmission reviews. We are currently seeking a registered nurse with extensive clinical auditing experience to join our Hospital Bill Review Department.
Candidate Profile
We are looking for a highly motivated individual with a strong background in clinical auditing. The ideal candidate will possess excellent communication skills, an analytical mindset, and the ability to thrive in a fast-paced environment.
Job Type
This is a full-time position (37.5 hours per week) from Monday to Friday. You will have the flexibility to telecommute from anywhere within the United States. Training will be provided virtually from your home.
Qualifications
Must be a registered nurse with an active RN license.
BSN or equivalent required.
2-5 years of auditing experience preferred; however, we will also consider candidates with Utilization Review, Managed Care, or Case Management experience.
2-5 years of experience in Medical Surgical or Critical Care settings required.
Proficiency in using Windows PC and multiple applications simultaneously.
Excellent computer skills, with knowledge of appeals and CMS guidelines preferred.
Responsibilities
Detail-oriented and highly organized with strong work ethic.
Solid understanding of anatomy, physiology, diagnostic, and surgical procedures.
Ability to accurately interpret medical records and write clear, concise clinical notes.
Maintain and manage case reviews with a focus on quality.
Work effectively in a high-volume production environment.
Knowledge of health insurance industry terminology and regulatory guidelines.
Ability to communicate effectively both orally and in writing.
Conduct appeal reviews as necessary.
Perform level of care reviews using Interqual guidelines.
Update hospital profiles as needed.
Remote Work Requirements
High-speed internet (100 Mbps per person recommended) with secured WiFi.
Dedicated workspace to ensure privacy and minimize interruptions.
Ability to sit and use a computer keyboard for extended periods.
Benefits
Comprehensive healthcare coverage including medical, dental, and vision plans for employees and dependents.
401(k) with employer match to invest in your future.
Generous paid time off, starting day one, and additional leave options.
Wellness programs, including commuter benefits and FSAs.
Continuous learning and development opportunities through mentorship and LinkedIn Learning.
Salary Range
$80,000 - $90,000 annually.
Employment Type: Full-Time
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Health Care Provider
Industries
Human Resources Services
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