Nurse Auditor, Hospital Bill Audits

Position Summary
At MedReview, our mission is to bring accuracy, accountability, and clinical excellence to healthcare. As such, we are a leading authority in payment integrity solutions including DRG Validation, Cost Outlier and Readmission reviews. We are seeking a registered nurse with extensive experience in clinical auditing to perform a bill review and chart validation within our Hospital Bill Review Department.
Candidate should be highly motivated, with strong clinical and auditing background. This individual must have excellent communication skills and an analytical mindset to achieve and maintain high-level performance in a fast-paced environment.
This is a fulltime position (37.5 hours per week) Monday – Friday. You’ll enjoy the flexibility to telecommute from anywhere within the United States. Training will be conducted virtually from your home.
If you are interested in this role with MedReview, please let us know. Here is what we are searching for:
Qualifications

• Must be a registered nurse with active RN license
• BSN or equivalent required
• 2-5 years auditing experience preferred, however will also consider Utilization Review, Managed Care, Case Management experience
• 2-5 years in either Medical Surgical or Critical Care experience required

• Ability to use Windows PC with the ability to utilize multiple applications at the same time
• Excellent computer skills
• Knowledge of appeals preferred
• Knowledge of CMS guidelines preferred

Responsibilities

• Must be detail oriented highly organized work skills
• Solid understanding of anatomy and physiology, diagnostic and surgical procedures
• Demonstrates the ability to accurately interpret what is transcribed in the medical record
• Writes clear, accurate and concise clinical notes in support of findings
• Maintains and manages case reviews with a high emphasis on quality
• Demonstrates the ability to work in a high – volume production environment
• Knowledge of health insurance business, industry terminology, and regulatory guidelines
• Accurately interprets Plan policies and appropriately applies to the clinical audit
• Ability to communicate effectively both orally and in writing
• Complete appeal reviews when needed
• Demonstrates the ability to perform a level of care review utilizing Interqual guidelines
• Maintain and update hospital profiles as needed

Remote Work Requirements

• High speed internet (100 Mbps per person recommended) with secured WIFI.
• A dedicated workspace with minimal interruptions to protect PHI and HIPAA information.
• Must be able to sit and use a computer keyboard for extended periods of time.

Benefits and perks include:

• Healthcare that fits your needs - We offer excellent medical, dental, and vision plan options that provide coverage to employees and dependents.
• 401(k) with Employer Match - Join the team and we will invest in your future
• Generous Paid Time Off - Accrued PTO starting day one, plus additional days off when you’re not feeling well, to observe holidays.
• Wellness - We care about your well-being. From Commuter Benefits to FSAs we’ve got you covered.
• Learning & Development - Through continued education/mentorship on the job and our investment in LinkedIn Learning, we’re focused on your growth as a working professional.

Salary:80k-90k

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