Nurse Auditor

Elevate Patient Financial Solutions®; United States; À distance; USD 65 000 - 90 000; Plein temps

Avantages offerts par ce poste

Medical, Dental & Vision Insurance

401K with generous company match

PTO 15 days

7 paid holidays

Floating holidays

Elevate Day (floating holiday)

Pet Insurance

Employee referral bonus program

Teamwork culture and growth

Résumé du poste

Elevate Patient Financial Solutions is seeking a Nurse Auditor for a fully remote role. The position supports the billing and reimbursement services team and runs regular audits to justify level of care.

You will prepare appeal letters when records do not support denials and assist with various denial reviews. Ideal candidates hold RN or LVN licensure with inpatient clinical experience and familiarity with InterQual/MCG criteria.

Qualifications

• Utilization review experience required
• Case management experience required
• Experience preparing and submitting authorizations
• Familiarity with InterQual and/or MCG criteria
• Inpatient clinical nursing experience preferred
• RN or LVN licensure required
• Remote/hybrid work requires reliable home internet connection

Responsabilités

• Perform regular audits of billing and reimbursement services
• Review patient medical records to justify level of care
• Prepare clinical reconsideration/appeal letters for payer denials
• Conduct DRG downgrade and payer utilization review activities
• Perform MAC and RAC audit tasks and related denial reviews
• Other duties as assigned in the billing and reimbursement services team

Connaissances

Utilization Review

Case Management

Authorizations

InterQual/MCG

Inpatient Nursing

RN License

LVN License

Formation

Registered Nurse license

Licensed Vocational Nurse license

Description du poste

Elevate Patient Financial Solutions has an exciting career opportunity available as a Nurse Auditor. This position will be a remote based role. The Full Time schedule for this role will be Monday through Friday 8 AM to 5 PM.

The Nurse Auditor is responsible for performing specialized administrative duties within the billing and reimbursement services department. The Nurse Auditor is responsible for running regular audits, reviewing medical records to justify level of care, and preparing appeal letters when gathered evidence does not support denial of services.

Essential Duties And Responsibilities

• Authorization Denials
• Prepare a clinical reconsideration/appeal letter to submit to the payer based on the evidence in the patient's medical records to justify either an acute level of care or skilled level of care (based on results from either MCG or InterQual review).
• Medical Necessity Denial Reviews
• Prepare a clinical reconsideration/appeal letter to submit to the payer based on the evidence in the patients' medical records that supports the necessity for denied services.
• Other Denial Reviews for Appeal:
• DRG Downgrades
• MAC & RAC Audits
• Payer Utilization Review Audits
• Experimental Procedures
• Charge Audits
• Other duties as assigned.

Qualifications And Requirements

• Utilization Review
• Case Management
• Preparing and submitting Authorizations
• Use of InterQual and/or MCG
• Inpatient Clinical Experience
• Registered Nurse; or
• Licensed Vocational Nurse
• Remote and Hybrid positions require a home internet connection that meets the company's upload and download speed criteria.

Benefits:

• Medical, Dental & Vision Insurance
• 401K (100% match for the first 3% & 50% match for the next 2%)
• 15 days of PTO
• 7 paid Holidays
• 2 Floating holidays
• 1 Elevate Day (floating holiday)
• Pet Insurance
• Employee referral bonus program
• Teamwork: We believe in teamwork and having fun together
• Career Growth: Gain great experience to promote to higher roles

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, location, specialty and training. This pay scale is not a promise of a particular wage.

The job description does not constitute an employment agreement between the employer and Employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

ElevatePFS is an Equal Opportunity Employer