Medical Review Clinical Appeals Auditor, RN – SNF/MDS
Employment Information
Job Description
Medical Review Clinical Appeals Auditor (RN) responsible for conducting Appeals reviews at Machinify. Seeking candidates with extensive auditing experience in healthcare claims.
Responsibilities:
- 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 annually
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