Clinical Audit Specialist

2 weeks ago


Dover, Kent, United Kingdom Intermountain Healthcare Full time
Job Summary:
As a Clinical Audit Specialist at Intermountain Healthcare, you will play a critical role in reviewing and analyzing medical records to ensure the clinical medical necessity of care appeals. With three years of experience in utilization review or care management, hospital insurance billing, third-party claim audits, or auditing in a healthcare setting, you will excel in this position. Your attention to detail and analytical skills will enable you to identify and communicate root causes for denials with members of the healthcare team.

About the Role:
The External Audit RN is responsible for managing, maintaining, and communicating all levels of denial and appeal activity to stakeholders. You will focus on reviewing and analyzing governmental denial rationales and provide appropriate medical necessity and level of care rationale for appeals. This role requires strong communication skills, both written and oral, to assure all discussions and appeals are filed timely with appropriate clinical rationale.

About You:
We seek an experienced professional who can serve as a subject matter expert for documentation requirements, clinical disease processes, and treatment. You must have a Bachelor of Science in Nursing (BSN) preferred, current licensure as a registered nurse in your state of practice, and experience in Microsoft Office, electronic medical record systems, and electronic databases. We offer a competitive hourly rate of $36.35-$54.53 and a comprehensive benefits package that covers a wide range of programs to foster a sustainable culture of wellness.

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