3 Clinical Review Auditor Jobs in Sarasota, FL
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Clinical Review Auditor
$69k-87k (estimate)
Full Time | Ambulatory Healthcare Services
4 Weeks Ago
Physicians Regional Healthcare System is Hiring a Clinical Review Auditor Near Sarasota, FL
Job DescriptionThis position requires a current Licensed Practical Nurse (LPN) or Registered Nurse (RN) license.
Essential Duties And Responsibilities(List in order of importance or percentage of time spent on the particular responsibility – High to LowMaintains a working mastery of industry-standard utilization review criteria (i.e.: Interqual), coverage guidelines, and payor medical policies
Demonstrates knowledge of governmental, managed care, and commercial denial/appeal policies
Appropriately reviews and triages denials for A/R, billing, downgrade, appeal, or denial adjustment
Able to prioritize and manage caseload without jeopardizing timely filing
Demonstrates excellent technical and clinical skills by drafting credible, defensible appeals
Conducts thorough evidence-based clinical literature research to support appeals, as needed
Understands and files appropriate levels of appeal (i.e.: reconsideration, dispute, appeal, ALJ…)
Accurately enters data into the Appeal Tracker, Cerner/ClaimIQ/Artiva, or other programs
Notifies department leadership regarding patterns/trends
10
Together works with department leadership and other Denial Management Team Members to develop and facilitate processes which promote job effectiveness and efficiency
12
Ability to perform all other duties as assigned or requested
13
Ensure confidentiality of all patient accounts by following HIPAA guidelines
Essential Duties And Responsibilities(List in order of importance or percentage of time spent on the particular responsibility – High to LowMaintains a working mastery of industry-standard utilization review criteria (i.e.: Interqual), coverage guidelines, and payor medical policies
Demonstrates knowledge of governmental, managed care, and commercial denial/appeal policies
Appropriately reviews and triages denials for A/R, billing, downgrade, appeal, or denial adjustment
Able to prioritize and manage caseload without jeopardizing timely filing
Demonstrates excellent technical and clinical skills by drafting credible, defensible appeals
Conducts thorough evidence-based clinical literature research to support appeals, as needed
Understands and files appropriate levels of appeal (i.e.: reconsideration, dispute, appeal, ALJ…)
Accurately enters data into the Appeal Tracker, Cerner/ClaimIQ/Artiva, or other programs
Notifies department leadership regarding patterns/trends
10
Together works with department leadership and other Denial Management Team Members to develop and facilitate processes which promote job effectiveness and efficiency
12
Ability to perform all other duties as assigned or requested
13
Ensure confidentiality of all patient accounts by following HIPAA guidelines
Job Summary
JOB TYPE
Full Time
INDUSTRY
Ambulatory Healthcare Services
SALARY
$69k-87k (estimate)
POST DATE
05/24/2024
EXPIRATION DATE
07/20/2024
WEBSITE
physiciansregional.com
HEADQUARTERS
NAPLES, FL
SIZE
200 - 500
FOUNDED
1999
TYPE
Private
CEO
ROLAND WERRES
REVENUE
$200M - $500M
INDUSTRY
Ambulatory Healthcare Services
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About Physicians Regional Healthcare System
Physicians Regional Medical Center provides health care services.
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