We partner with over 1,000 healthcare providers to maximize their complex claims reimbursements.
Nurse Review Auditor
Location
Tennessee
Posted
1 day ago
Salary
Not specified
Seniority
Mid Level
Job Description
Job Requirements
- Active RN license with ADN or BSN required. Compact State licensure preferred.
- Minimum of 2 years’ experience in:
- Medical Necessity Reviews
- Admission/Length of Stay
- LCD/NCD interpretation and application
- DRG validation and downgrade reviews
- Line-item reviews
- 3-5 years’ acute care hospital experience in one of more of the following:
- ICU/Trauma
- Surgery
- Orthopedics
- Neurosurgery
- Strong knowledge of payer policies, CMS guidelines, and nationally recognized medical review standards.
- Elevated level of analytical ability and attention to detail
- Excellent written and verbal communication skills
Benefits
- EnableComp is an Equal Opportunity Employer M/F/D/V. All applicants will be considered for this position based upon experience and knowledge, without regard to race, color, religion, national origin, sexual orientation, ancestry, marital, disabled or veteran status.
- We are committed to creating and maintaining a workforce environment that is free from any form of discrimination or harassment.
- EnableComp recruits, develops and retains the industry's top talent. As the employer of choice in the complex claims industry, EnableComp takes pride in our continuous commitment to building and maintaining a culture centered around fostering the professional growth and development of our people.
- We believe that investing in our employees is the key to our success, and we are dedicated to providing them with the tools, resources, and support they need to thrive and grow their career here.
- At EnableComp, we are committed to living up to our core values each and every day, and we believe that this commitment is what sets us apart from other companies.
Related Guides
Related Categories
Related Job Pages
More Auditor Jobs
Lead Auditor for regulatory compliance in Aerospace product and quality systems
Pharmacy Claims Auditor
Independence Blue CrossIBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together, we will achieve our mission to enhance the health and well-being of the people and communities we serve. The Auditor, Payment...
Assistant Manager - High Cost Drug (HCD) Auditor II
EXLWe make sense of data to drive your business forward. #MakeSenseofData #DriveYourBusinessForward #PartnerYourWay
Conduct comprehensive HCPCS coding reviews, analyze medical records for discrepancies, apply industry guidelines for claims, and document audit findings clearly and effectively while maximizing overpayment identifications.
The role involves scheduling and conducting in-person and virtual premium audits for Workers’ Compensation and General Liability exposures, requiring regular travel up to one hour to assigned sites. Responsibilities also include collecting and verifying documentation, preparing detailed audit reports, and maintaining professional communication with clients and stakeholders.



