Clinical Auditor, RN

🕒 May 12

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Briljent

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 1998

📚 Education

🏛️ Government

Education • Government • Consulting

Briljent is a consulting firm founded in 1998 that specializes in organizational change management, learning strategy, and instructional design. They focus on needs analysis, program management, and performance strategy implementation across various sectors including social services, education, healthcare, and information technology. Briljent is committed to creating diverse work environments and supporting individual career development. Their services cater to government agencies and corporate clients, providing customized learning solutions, change management consultation, and ongoing support to improve organizational performance and adaptability. They have delivered 2. 5 million training hours and served 16 Fortune 500 companies.

📋 Description

• Support medical record reviews, billing compliance audits for the Indiana Health Coverage Programs. • Evaluate quality of care, reviewing medical records and program policies and identifying compliance issues. • Prepare audit documentation and reports, and support appeals activities. • Conduct medical record and compliance reviews independently and provide preliminary findings to the Lead Reviewer. • Identify potential documentation deficiencies, and billing compliance issues. • Maintain detailed workpapers documenting procedures performed, records reviewed, findings identified, and conclusions reached. • Assist with audit responses and appeals as needed. • Ensure all work aligns with state, federal, and national healthcare and Medicaid guidelines.

🎯 Requirements

• RN license preferred; Indiana license or compact license accepted. • Coding certification such as CCS or CPC strongly preferred. • At least 1 year of Medicaid claims review, billing compliance, or healthcare reimbursement experience. • Familiarity with Indiana Medicaid policies, payer guidelines, and documentation requirements preferred. • Knowledge of CPT coding guidelines and ICD-10 standards. • Proficiency in Microsoft Excel, Word, and Outlook. • Strong analytical, critical thinking, problem-solving, and technical writing skills. • Ability to work independently and collaboratively in a fast-paced environment. • Experience working with healthcare providers strongly preferred. • Knowledge of healthcare claims data and fraud, waste, and abuse preferred.

🏖️ Benefits

• Solutions come from creative ideas; ideas come from being creative with differences. • Briljent believes diversity and inclusion are critical to the success of the company. • We do not discriminate against any employee or applicant because of race, creed, color, religion, gender, sexual orientation, national origin, disability, age, veteran status, marital status or any other basis protected by federal, state or local law, regulation or ordinance.