Remote Nurse Auditor Non Exempt

Medical University of South Carolina; South Carolina; Remote; USD 80,000 - 100,000; Full time

Job summary

Join the Medical University of South Carolina to oversee denied medical claims, ensuring accurate appeals for optimal reimbursement. This role requires a passionate registered nurse with effective communication skills and a commitment to collaborative patient care.

Qualifications

• Minimum of one year work experience as a registered nurse required.
• RN licensure by the South Carolina Board of Nursing or a compact state is mandatory.
• Current BLS certification is required.

Responsibilities

• Review denied claims from all payers regarding medical necessity.
• Manage and communicate denial and appeal activities.
• Collaborate with interdepartmental staff, clinicians, and non-clinicians.

Skills

Communication

Critical Thinking

Collaboration

Education

Bachelor of Nursing degree

Tools

Basic Life Support (BLS)

Job description

Job Description Summary

Entity

Medical University Hospital Authority (MUHA)

Worker Type

Employee

Worker Sub-Type

Regular

Cost Center

CC002309 SYS - Hospital Patient Accounting

Pay Rate Type

Hourly

Pay Grade

Health-27

Scheduled Weekly Hours

40

Work Shift

Job Description

Responsible for the timely review of denied claims from all payers related to medical necessity, appropriate setting, status determination, authorizations, and appropriate length of stay. Ensure all denied claims are accurately worked and appealed to obtain maximum reimbursement and minimize recoupment. Actively manage, maintain, and communicate denial/appeal activity and/or emerging trends related to payer denials to denials manager and/or supervisor. Collaborate with other interdepartmental staff, clinicians, and/or non-clinicians.

Additional Job Description

Bachelor of Nursing degree preferred. RN staff hired on or after July 1, 2013 with an Associate or Diploma degree in nursing are required to be enrolled in an accredited BSN program within two years and successfully obtain a BSN degree within four years of the RN hire or reclassification date. Refer to policy A141 for more details. A minimum of one year of work experience as a registered nurse required. Licensure as a registered nurse by the South Carolina Board of Nursing or a compact state. Current American Heart Association (AHA) Basic Life Support (BLS) certification or American Red Cross BLS for Healthcare Providers certification is required

If you like working with energetic enthusiastic individuals, you will enjoy your career with us!

The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.

Medical University of South Carolina participates in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees. For further information about the E-Verify program, please click here: http://www.uscis.gov/e-verify/employees