Medical Review Clinical Appeals Auditor, RN

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🕒 March 31

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Logo of BASF

BASF

10,000+ employees

Founded 1865

🌾 Agriculture

Chemicals • Agriculture • Healthcare

BASF is a global chemical company that operates across multiple sectors, providing a wide range of products and solutions. The company is focused on innovation and sustainability, serving industries such as agriculture, automotive, construction, electronics, energy, and healthcare. With a commitment to research and development, BASF aims to create chemicals that enhance the quality of life and support sustainable practices worldwide.

📋 Description

• Conduct Appeals reviews of new evidence presented by auditees • Document Appeals results according to quality policies • Review audit documentation and conduct research • Provide corrections to rationale correlating with audit determinations • Contribute to continuous improvement feedback processes • Monitor, track, and report all work conducted

🎯 Requirements

• Active unrestricted RN license in good standing • At least 5+ years relevant experience in a provider or payer environment • Strong technical aptitude and intermediate to advanced skills using Excel • ICD-9/ICD-10 coding knowledge • Experience in health care claims that demonstrates expertise in bundled payment methodologies and/or medical billing • Familiarity with interpreting electronic medical records (EHR)

🏖️ Benefits

• Medical insurance • Dental insurance • Vision insurance • HSA/FSA options • Life insurance coverage • 401(k) savings plans • Family/parental leave • Paid holidays • Paid time off annually

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