Remote Nurse Auditor: Appeals & Denials Specialist

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 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.