RN Chart Auditor | Managed Care

Company Name:
Edge Recruitment Solutions
Were working on behalf of a nonprofit health care company that offers individual and group medical, dental, vision and life insurance, Medicare and other government programs as well as pharmacy benefit management. The company is the largest health insurer in the Northwest/Intermountain Region, serving members Idaho, Oregon, Utah, and Washington. The company is firmly committed to being a catalyst that transforms health care, creating a system transformation and a consumer focus that makes health care more affordable and understandable for individuals and families, and facilitates an economically sustainable relationship between patients and providers. This commitment drives its companies and employees every day.
Looking for a great opportunity with an established leader? We seek a Registered Nurse with chart auditing experience for the role of Nurse Auditor. In this role you will apply your clinical expertise and judgment to ensure payments comply with medical policy, medical necessity guidelines, and accepted standards of care. You will utilize evidence-based criteria that incorporates current and validated clinical research findings. You will understand and analyze complex provider and hospital contracts in order to ensure payments are for covered services. You will conduct coding audits, quality assurance assessments of claims, review statistical samples, and analyze for risk. You will conduct surveys of complex audit areas to define the scope and objectives of audits. You will assist in the development of overall audit plans, including comprehensive audit programs that identify specific procedures and tests designed to achieve the audit objectives.
Candidates must be a graduate of an accredited school of nursing and be licensed as an RN in the state of Washington. Candidates must have five (5) or more years of hospital quality management, coding or medical auditing experience or equivalent combination of education and experience. Strong preference given to candidates who have chart auditing experience in a Skilled Nursing Facility. Strong preference also given to candidates who hold certification as a Certified Coder with the American Academy of Professional Coders (AAPC) or the American Health Information Management Association (AHIMA).
Competitive compensation and excellent benefits. This is an excellent opportunity for those who seek a career that affects change in the health care system, making health care more affordable and accessible and increasing consumers engagement in their health care decisions. For more information call 941.739.1400 or submit your resume now by clicking on the button below that says "Click Here to Apply Online."

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