Nurse Auditor

A company is looking for a Nurse Auditor to perform specialized administrative duties within the billing and reimbursement services department. Key Responsibilities Perform regular audits and review medical records to justify levels of care Prepare clinical reconsideration and appeal letters for authorization and medical necessity denials Conduct various denial reviews, including DRG downgrades and payer utilization review audits Qualifications and Requirements Registered Nurse or Licensed Vocational Nurse Experience in Utilization Review and Case Management Familiarity with preparing and submitting authorizations Experience using InterQual and/or MCG Inpatient clinical experience required

Apr 16, 2025 - 01:15

A company is looking for a Nurse Auditor to perform specialized administrative duties within the billing and reimbursement services department. Key Responsibilities Perform regular audits and review medical records to justify levels of care Prepare clinical reconsideration and appeal letters for authorization and medical necessity denials Conduct various denial reviews, including DRG downgrades and payer utilization review audits Qualifications and Requirements Registered Nurse or Licensed Vocational Nurse Experience in Utilization Review and Case Management Familiarity with preparing and submitting authorizations Experience using InterQual and/or MCG Inpatient clinical experience required