Ensemble Health Partners logo
Ensemble Health Partners

Innovation in Revenue Cycle Management

RN Clinical Auditor

AuditorAuditorFull TimeRemoteMid LevelTeam 5,001-10,000H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

1 day ago

Salary

$63.1K - $108.9K / year

Seniority

Mid Level

Associate Degree2 yrs expEnglish

Job Description

• Perform complete government, state, and commercial payer clinical audit reviews • Analyze and review clinical audit and DRG clinical validation audits • Gather appropriate medical records from client EMR per government requirements • Contact regulatory bodies to determine the reason for the audit • Review audit letters and analyze claims • Prepare audit materials and respond to requests for additional documentation • Collaborate with healthcare providers and educate staff on best practices and audit outcomes • Participate in the development of clinical guidelines and protocols

Job Requirements

  • 2+ years of regulatory audit experience, utilization review, clinical validation, denials or case management experience strongly preferred
  • Experience in hospital operations, chart audit/review, and clinical education
  • Ability to manage time, meet audit deadlines, and handle multiple tasks.
  • Experience working in a production-based work environment
  • Flexibility to adapt to changing regulations, work multiple assigned audit tasks and healthcare environments.
  • Ability to work independently and manage workload.
  • Ability to evaluate complex situations and make informed decisions.
  • Familiarity with electronic medical records (EMR) systems.
  • Experience using multiple software programs and tools.
  • Must be inquisitive and demonstrate openness to innovation including AI to explore better processes and ways to alleviate friction and improve patient and client experiences.

Benefits

  • Bonus Incentives
  • Paid Certifications
  • Tuition Reimbursement
  • Comprehensive Benefits
  • Career Advancement

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