Audit Reviewer
Knowtion Health
- Florence, South Carolina, United States
- Florence, South Carolina, United States
About
What’s Attractive to the Right Candidate?
Knowtion Health is a growing firm in a growing industry. Our status as a leader in this industry means that we have the resources to invest in the business and to innovate.
Our business is intensely competitive and is constantly evolving. We quickly identify new challenges and develop solutions, so you won’t simply be doing what was done last year. Our new employees are frequently pleased and surprised by how quickly we make decisions and adapt to market conditions.
Knowtion Health culture is inviting and competitive, embracing challenge and celebrating accomplishment; dedicated colleagues striving to provide quality results that have lasting impact.
The Opportunity:
Reviews medical record documentation to verify clinical indicators and coding issues as related to DRG Validation Audits, Emergency Department Downgrade Audits, Inpatient Level of Care Audits, and Charge Outlier Audits, etc.
Creates detailed appeal letters for denials from payer to support payment of patient claims
Manages Inventory and Follow up on accounts as appropriate
Reviews InterQual/Milliman, coding guidelines and/or payer medical policies related to denied procedures or services and includes criteria in appeals letter as appropriate
Provides feedback to supervisor regarding issues identified for ongoing training to peers and non-clinical staff members
Identifies root causes and trends to share with clients and staff
Works with peers in collaboration of clinical writing situations
What you bring:
Current and valid RN License or Coder with 3 years inpatient experience.
Two years of experience in an acute care hospital (Med/Surg) preferred.
Five years of experience in clinical medical record audits or coding preferred.
Experience using InterQual and Milliman healthcare criteria preferred
Experience reviewing CMS LCD/NCD criteria preferred
Knowledge of CMS and payer reimbursement guidelines preferred
Knowledge of DRG, ICD-10, CPT and HCPCS codes preferred
Comfort with productivity standards
The above statements are intended to provide the general nature and level of work being performed by most people assigned to the position. They are not intended to be an exhaustive list of all responsibilities, duties and requirements.
This position is remote and requires a dedicated, distraction-free work space at home. We offer a competitive benefits package including medical, dental, vision, life insurance, short term disability, long term disability, bonus opportunities, paid holidays, 401k, and a generous PTO policy.
Knowtion Health gives priority to applicants located in the following states: AL, AR, AZ, FL, GA, ID, IN, KS, ME, MI, MO, MS, NC, NM, OK, PA, SC, TN, TX, VA, WI, WV
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Languages
- English
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