Clinical Appeals Review Nurse

Since 1984, UASI has been one of the largest independent healthcare revenue cycle consulting firms in the United States. UASI is a nationally-recognized leader in the Health Information Management field, weaving technology, expertise, & flexible problem solving together to create effective strategies for each healthcare client. UASI offers services and employment opportunities in Remote Coding, Coding Compliance Review, Education and Training, Clinical Documentation Improvement, HIM and Coding Interim Management, and Revenue Integrity. Our client base includes top-ranked hospitals for academics, research, quality, and patient care. Through this broad client base, remote-employment opportunities, and multiple service offerings, we engineer individual career paths and encourage balance for each employee. As medical coding and regulatory compliance demands continue to increase for every healthcare organization, UASI works within the core values on which our company was founded and offers the newest solutions for producing low-cost, high-quality records.

United Audit Systems, Inc. (UASI), a rapidly growing healthcare consulting firm seeks to expand its professional team of employees by adding experienced Clinical Appeals Review Nurse to our team. The ideal candidate will have a combination of clinical experience in a hospital acute care setting and experience providing reviews of the hospital billing and charging policies.

DRG Denials Perform a variety of audit services including charge audit, compliance audit, medical necessity, denials and other requests as needed. Audits may be performed on a concurrent or retrospective basis Review and analyze the client inpatient and/or outpatient itemized billing statement and the patient medical record and related documentation to identify items that were not billed correctly. Document findings on appropriate form and submit findings to client management staff daily so new billing forms can be generated in hospitals billing systems. Adhere to the National Health Care Billing Audit Guidelines, UASI Code of Conduct and Compliance Program, and the client third party audit policy while performing all duties. Attend meetings with members of client-hospital finance, medical records, and ancillary departments. Educate Client-Hospital personnel on validation and documentation of charges if requested by client contract relationship. Navigate hospitals medical record system and understand where to locate the financial information in relation to the patient payor billing information