The RN Nurse Auditor is a key member of the Clinical Appeals team responsible for advocating for appropriate reimbursement and contributing to the financial health of the organization
Job Summary
The RN Nurse Auditor is a key member of the Clinical Appeals team responsible for advocating for appropriate reimbursement and contributing to the financial health of the organization.
This role involves identifying denial trends, conducting root cause analysis, and producing actionable reports to drive continuous improvement across Revenue Cycle operations.
The RN Nurse Auditor collaborates with Hospital Patient Accounting, Revenue Integrity, Case Management, Utilization Review, Compliance, and clinical departments to mitigate denial risks and ensure clinical documentation supports reimbursement integrity.
Matching Summary
The RN Nurse Auditor is a key member of the Clinical Appeals team responsible for advocating for appropriate reimbursement and contributing to the financial health of the organization.
Skills & Requirements
Must-have
clinical reviews of payer audit determinations
knowledge of payer reimbursement policies
regulatory compliance standards
collaboration with clinical and revenue departments
root cause analysis of denial trends
preparation of detailed appeals
Nice-to-have
strong clinical judgment
excellent written and verbal communication skills
ability to work rotating shifts
ability to work overtime
ability to deal effectively with stressful situations
work in latex safe environment
Key Requirements
Bachelor's degree in Nursing
minimum of three years related nursing experience
Registered Nurse licensure by South Carolina Board of Nursing or compact state