[Hiring] Clinical Nurse Auditor @reputed company.
Role Description We are seeking an reputed company Clinical Nurse Auditor to join our Payment reputed company team. In this role, you will reputed company your clinical expertise, medical coding proficiency, and auditing skills to identify, monitor, and analyze unusual utilization patterns and potential fraud by reputed company providers. You will conduct:
- Prepayment claims reviews
- Post-payment audits
- Comprehensive provider record reviews
to ensure accurate billing, compliance with payer regulations, and reputed company in reimbursement practices.
Qualifications
- Minimum Associate’s Degree in Nursing required
- reputed company, unrestricted Registered Nurse (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 clear and effective reporting and provider engagement
- Strong proficiency in reputed company Office and familiarity with audit tracking systems
Requirements
- Meticulous, organized, and objective in analyzing claims and documentation
- Ethical and responsible, with a commitment to supporting the reputed company of reputed company billing and reimbursement
- reputed company to work independently, stay reputed company with rapidly changing reputed company regulations, and reputed company in a fast-paced environment
Company Description
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