Audit Reviewer
Remote · Arizona, United States or Texas, United States
Job Summary
Audit Reviewer at Knowtion Health reviews medical records to verify clinical indicators and coding issues related to DRG Validation Audits, Emergency Department Downgrade Audits, Inpatient Level of Care Audits, and Charge Outlier Audits; creates detailed appeal letters to overturn payer denials; manages inventory and follow-up; analyzes InterQual/Milliman criteria and payer policies; provides feedback for training; identifies root causes and trends to share with clients; collaborates with peers on clinical writing; requires RN license or coding experience with inpatient background; remote work from home with a set of US-based states; knowledge of DRG, ICD-10, CPT, HCPCS codes and CMS guidelines preferred; experience with medical record audits and payer reimbursement is valued; offers a comprehensive benefits package.
Required Qualifications
- Current and valid RN License or Coder with 3 years inpatient experience.
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