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Florida Licensed Clinical Review Auditor
A company is looking for a Clinical Review Auditor. Key Responsibilities Manage the denial/appeal process through comprehensive reviews of clinical and claim documentation Draft and submit defensible appeals according to payer guidelines to secure appropriate reimbursement Maintain knowledge of utilization review criteria and denial/appeal policies, while accurately entering data into relevant systems Required Qualifications Current RN/LPN licensure in the state of Florida High School Diploma; Nursing Degree Clinical experience in an acute care setting Knowledge of Word Processing, Spreadsheet, and Email software Detail-oriented with current knowledge of healthcare pathophysiology concepts
A company is looking for a Clinical Review Auditor.
Key Responsibilities
Manage the denial/appeal process through comprehensive reviews of clinical and claim documentation
Draft and submit defensible appeals according to payer guidelines to secure appropriate reimbursement
Maintain knowledge of utilization review criteria and denial/appeal policies, while accurately entering data into relevant systems
Required Qualifications
Current RN/LPN licensure in the state of Florida
High School Diploma; Nursing Degree
Clinical experience in an acute care setting
Knowledge of Word Processing, Spreadsheet, and Email software
Detail-oriented with current knowledge of healthcare pathophysiology concepts