Key skills
Change Management
About this role
Role Overview
- Perform Readmission or Short Stay clinical audits to ensure that medical record documentation and diagnosis coding for services rendered is complete, compliant and accurate to support optimal reimbursement
- Validate and interpret medical documentation to ensure capture of all relevant admission types
- Identifies the root cause analysis of audit findings and submits recommendations for appropriate change management
- Apply clinical experience to conduct reviews of provider services and billing
Requirements
- Active Registered Nurse (RN) license, in your state of residence
- 3 or more years of acute or critical care inpatient bedside nursing experience
- 1 or more years of claim review or auditing experience
- Associate or Bachelor's Degree
- Milliman Care Guidelines
- Clinical documentation improvement (CDI) knowledge
- Case Management or Discharge planning in an acute care setting
Benefits
- medical, dental and vision benefits
- 401(k) retirement savings plan
- time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
- short-term and long-term disability
- life insurance and many other opportunities