Clinical Denials Auditor

🕒 July 2

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $80k - $105k / year

⏰ Full Time

🟢 Junior

🔎 Auditor

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Huron

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 2002

🏥 Healthcare

📦 Logistics

📣 Marketing

Healthcare • Logistics • Marketing

Huron Consulting Group is a global consultancy that provides a wide range of services including strategy, operations, advisory, digital, technology, and analytics solutions to various sectors such as healthcare, education, energy, and financial services. Huron helps organizations navigate complex challenges and drive growth through tailored solutions and innovative strategies. The company employs a team of experts dedicated to delivering high-impact solutions that address the unique needs of each client, focusing on areas such as managed services, outsourcing, and leadership development.

📋 Description

• Assist Utilization and Denials management in preparing daily operational reports • Provide QA (quality assurance) feedback for Utilization and Denials Management specialists • Monitor performance using key metrics for Utilization Management and Clinical Denials & Appeals • Communicate progress across the Team to the Manager • Mentor staff to maximize performance and potential • Conduct monthly team meetings and annual performance evaluations • Partner with global Operations, Training, and HR to streamline onboarding and OJL

🎯 Requirements

• At least 1 year of Utilization management and/or Clinical appeals writing QA or auditing experience in healthcare setting • Minimum of 3-5 years acute care clinical experience in a hospital setting (Med/Surg, or similar preferred); 2-3 years of ICU experience • Associate Degree in Nursing (ADN) or Diploma in Nursing • Must be Registered Nurse and hold an active USRN license • Proficiency in using InterQual or MCG clinical guidelines • Broad Knowledge of U.S. Government Programs and Insurance Regulations • Proficiency with hospital-based electronic medical records (EMR) such as Epic, Cerner, or Meditech.

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • 401(k) plan with employer match • Paid Time Off policy • Paid parental leave • Adoption assistance • Free annual health screenings • Coaching and wellness programs