Audit Reviewer
Remote · Emporia, Kansas, United States
Job Summary
Audit Reviewer reviews medical record documentation 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 for payer denials to support payment of patient claims; manages inventory and follow-up on accounts; reviews InterQual/Milliman criteria and payer policies to inform appeals letters; provides feedback for training; identifies root causes and trends; collaborates with peers on clinical writing; remote position with dedicated home workspace; priority to applicants in multiple states; benefits package offered.
Required Qualifications
- Current and valid RN License or Coder with 3 years inpatient experience
- Two years of experience in an acute care hospital (Med/Surg) preferred
- Five years of experience in clinical medical record audits or coding preferred
- Experience using InterQual and Milliman healthcare criteria preferred
- Experience reviewing CMS LCD/NCD criteria preferred
- Knowledge of CMS and payer reimbursement guidelines preferred
- Knowledge of DRG, ICD-10, CPT and HCPCS codes preferred
- Comfort with productivity standards
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