Nurse Auditor Non Exempt
| Company | Medical University of South Carolina |
|---|---|
| Location | South Carolina, USA |
| Salary | $Not Provided – $Not Provided |
| Type | Full-Time |
| Degrees | Bachelor’s |
| Experience Level | Junior |
Requirements
- Bachelor of Nursing degree preferred
- A minimum of one year of work experience as a registered nurse required
- Licensure as a registered nurse by the South Carolina Board of Nursing or a compact state
- Current American Heart Association (AHA) Basic Life Support (BLS) certification or American Red Cross BLS for Healthcare Providers certification is required
Responsibilities
- Responsible for the timely review of denied claims from all payers related to medical necessity, appropriate setting, status determination, authorizations, and appropriate length of stay
- Ensure all denied claims are accurately worked and appealed to obtain maximum reimbursement and minimize recoupment
- Actively manage, maintain, and communicate denial/appeal activity and/or emerging trends related to payer denials to denials manager and/or supervisor
- Collaborate with other interdepartmental staff, clinicians, and/or non-clinicians
Preferred Qualifications
-
No preferred qualifications provided.