Rn Nurse Auditor

Medical University Hospital Authority (MUHA)

Charleston, South Carolina, US
Clinical judgment
Payer policies knowledge
Regulatory compliance standards
The RN Nurse Auditor is responsible for conducting clinical reviews of payer audit determinations, identifying improper denials, and preparing detailed appeals that support the validity of charges and medical necessity of services rendered

Job Summary

  • The RN Nurse Auditor is responsible for conducting clinical reviews of payer audit determinations, identifying improper denials, and preparing detailed appeals that support the validity of charges and medical necessity of services rendered.
  • This role utilizes strong clinical judgment, in-depth knowledge of payer policies, and regulatory compliance standards to advocate for appropriate reimbursement and contribute to the financial health of the organization.
  • The RN Nurse Auditor also identifies denial trends, conducts root cause analysis, and produces actionable reports to drive continuous improvement across Revenue Cycle operations.

Matching Summary

The RN Nurse Auditor is responsible for conducting clinical reviews of payer audit determinations, identifying improper denials, and preparing detailed appeals that support the validity of charges and medical necessity of services rendered.

Skills & Requirements

Must-have

  • Clinical judgment
  • Payer policies knowledge
  • Regulatory compliance standards
  • Revenue Cycle operations
  • Clinical documentation support

Nice-to-have

  • Energetic enthusiastic individuals
  • Continuous improvement focus
  • Collaborative team environment

Key Requirements

  • Bachelor's degree in Nursing
  • Three years related nursing experience
  • Knowledge of payer reimbursement
  • Registered Nurse licensure
  • BLS certification

Work Rights

Not specified

Tailored Resume

Cover Letter