Nurse Auditor I

ROLE AND RESPONSIBILITIES:

• Independently audit clinical documentation to ensure consistent with billed services in a production environment.
• Apply clinical and industry guidelines, payer P&P, and use in-depth knowledge to support medical necessity.
• Develop relationships with medical providers and health plans to confirm adherence to guidelines.

QUALIFICATIONS:

• Active RN or LPN professional license in good standing.
• 5 years of clinical practice.
• Well-developed verbal and written communication skills.

MENTAL AND PHYSICAL DEMANDS:

• Sedentary work, sitting most of the time, with typing and repetitive motion using computer software.
• Concentrating on analytical tasks, reading information, and communicating continuously.