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Medical Auditor RN (Remote- UR and Auditing experience preferred)
JOB SUMMARYThe Medical Auditor RN assesses and develops policies and procedures for medical audit programs, insuring that audit procedures are maintained and adhered to and are compliant with state and national regulations.ESSENTIAL FUNCTIONS OF THE ROLEDevelops a multi-faceted audit plans, including for Diagnosis-Related Group (DRG) and Ambulatory Payment Classifications (APC) validations, inpatient and outpatient hospital billing, skilled nursing facility audits, contract terms validations, high cost drug audits, itemized bill reviews and durable medical equipment audits. Monitors audit plans over time for continual processes improvement.Analyzes current provider cont
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