Nurse Auditor

Elevate Patient Financial Solutions has an exciting career opportunity available as a Nurse Auditor. This position will be a remote based role. The Full Time schedule for this role will be 8am-5pm, Monday-Friday. The Nurse Auditor is responsible for performing specialized administrative duties within the billing and reimbursement services department. The Nurse Auditor is responsible for running regular audits, reviewing medical records to justify level of care, and preparing appeal letters when gathered evidence does not support denial of services.

Authorization Denials Prepare a clinical reconsideration/appeal letter to submit to the payer based on the evidence in the patient’s medical records to justify either an acute level of care or skilled level of care (based on results from either MCG or InterQual review). Medical Necessity Denial Reviews Prepare a clinical reconsideration/appeal letter to submit to the payer based on the evidence in the patients’ medical records that supports the necessity for denied services. Other Denial Reviews for Appeal: DRG Downgrades MAC & RAC Audits Payer Utilization Review Audits Experimental Procedures Charge Audits Other duties as assigned.