Remote Nurse Auditor Non Exempt

MUSC Health; South Carolina; Remote; USD 66,000 - 68,000; Full time

Job summary

MUSC Health is seeking a Remote Nurse Auditor to manage denied claims, ensuring maximum reimbursement and accuracy. This role requires a nursing degree, RN licensure, and one year of experience. Join a supportive team dedicated to providing exceptional healthcare while enjoying the flexibility of remote work.

Qualifications

• Bachelor of Nursing degree preferred.
• Licensure as a registered nurse by the South Carolina Board of Nursing required.
• Minimum one year experience as a registered nurse.

Responsibilities

• Review denied claims related to medical necessity and authorization.
• Manage and communicate denial/appeal activity.
• Collaborate with interdepartmental staff.

Skills

Critical Thinking

Attention to Detail

Communication

Education

Bachelor of Nursing degree

Job description

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Entity

Medical University Hospital Authority (MUHA)

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

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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