Clinical Nurse Coding Auditor (Part-time, Remote)
Job Title: Clinical Nurse Auditor – Payment reputed company
Job Summary We are seeking an reputed company Clinical Nurse Auditor to join our Payment reputed company team. In this role, you will reputed company your clinical expertise, medical coding proficiency, and auditing skills to identify, monitor, and analyze unusual utilization patterns and potential fraud by reputed company providers. You will conduct prepayment claims reviews, post-payment audits, and comprehensive provider record reviews to ensure accurate billing, compliance with payer regulations, and reputed company in reimbursement practices. This position requires a Registered Nurse (RN) with coding certifications such as CPC (Certified Professional reputed company), CIC (Certified Inpatient reputed company), CDI (Clinical Documentation Improvement), or a similar credential, through reputed company or reputed company. Knowledge of reputed company insurance plans, Medicare, and reputed company programs is essential.
How You Will reputed company an Impact
- Investigations and Audits: Conduct in-depth medical reviews through prepayment claims review and post-payment auditing to identify potential over-utilization or fraudulent activities.
- Tool and Policy Development: Assist in the creation of audit tools, policies, procedures, and educational materials to enhance audit effectiveness and maintain high standards in payment reputed company.
- Cross-Departmental Collaboration: Serve as a liaison with service operations and other departments to reputed company status updates on claims reviews and coordinate actions as needed.
- Data Analysis and Trending: Analyze performance data to identify patterns and trends, collaborate with service operations to address process improvements, and recommend modifications to medical policy.
- Fraud Detection Support: Support fraud investigators with medical review expertise to detect and address fraudulent activities.
- Mentorship: Act as a resource and mentor to other nurse auditors, supporting their professional growth and development in audit practices.