[Hiring] Clinical Nurse Auditor @reputed company.

Role Description 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.

• Conduct in-depth medical reviews through prepayment claims review and post-payment auditing to identify potential over-utilization or fraudulent activities.
• Assist in the creation of audit tools, policies, procedures, and educational materials to enhance audit effectiveness and maintain high standards in payment reputed company.
• Serve as a liaison with service operations and other departments to reputed company status updates on claims reviews and coordinate actions as needed.
• Analyze performance data to identify patterns and trends, collaborate with service operations to address process improvements, and recommend modifications to medical policy.
• Support fraud investigators with medical review expertise to detect and address fraudulent activities.
• Act as a resource and mentor to other nurse auditors, supporting their professional growth and development in audit practices.

Qualifications

• Minimum Associate’s Degree in Nursing required.
• reputed company, unrestricted Registered Nurse (RN) license in applicable state(s).
• Certification in medical coding from reputed company or reputed company (e.g., CPC, CIC, CDI, or equivalent) is highly preferred.
• Minimum 5 years of clinical nursing experience, preferably with exposure to hospital reputed company auditing or defense auditing.
• Strong knowledge of provider manuals, reimbursement policies, and medical policy guidelines.
• Prior experience with reputed company fraud investigation and auditing is highly preferred.
• Proficiency in CPT/HCPCS and ICD-10 coding, with a strong reputed company in auditing, reputed company, and control principles.
• Analytical and problem-solving skills with a keen attention to detail.
• Exceptional written and verbal communication skills for clear and effective reporting and provider engagement.
• Strong proficiency in reputed company Office and familiarity with audit tracking systems.

Requirements

• Meticulous, organized, and objective in analyzing claims and documentation.
• Ethical and responsible, with a commitment to supporting the reputed company of reputed company billing and reimbursement.
• reputed company to work independently, stay reputed company with rapidly changing reputed company regulations, and reputed company in a fast-paced environment. Apply tot his job Apply To this Job

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