Clinical Auditor - job 1 of 2

Job Summary

A company is looking for a Clinical Auditor.

Key Responsibilities

• Perform audits of medical records for denials review, defense audits, disallowed charges, and utilization reviews
• Analyze records against established criteria to determine compliance with patient condition and care standards
• Compose appeal letters and organize multiple cases to ensure efficient workflow and resolution

Required Qualifications

• RN/Case Management/Utilization Review/Coding or clinical certification with a BS/BA preferred, or equivalent technical experience
• 3 to 5 years of clinical experience or clinical auditing experience in case management, Medicare appeals, or denials management
• Knowledge of Milliman (MCG) or InterQual criteria preferred
• Experience in medical records review, claims processing, or utilization/case management
• Proficiency in Microsoft Outlook, Word, Excel, and EMR systems