Medical Review Clinical Appeals Auditor, RN – SNF/MDS

Job Description: • Conduct Appeals reviews of new evidence presented by auditees • Objectively and accurately document Appeals results according to department quality policies • Review audit documentation and conduct research, analyze claims data • Monitor, track, and report on all work conducted in accordance with Appeals process • Contribute to the continuous improvement feedback process and audit results • Support training material/tools and best practices development Requirements: • Active unrestricted RN license in good standing • At least 5+ years relevant experience in a provider or payer environment • Strong technical aptitude and intermediate to advanced skills using Excel • One or more years of experience in health care claims including ICD-9/ICD-10 coding • Strong preference for experience performing utilization review for an insurance company, Tricare, MAC or similar. Benefits: • medical, dental, vision, HSA/FSA options • life insurance coverage • 401(k) savings plans • family/parental leave • paid holidays • paid time off annuallyApply Now Apply Now