Clinical Denials Auditor

🔥 0 minutes ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $33 - $43 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

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Huron

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 2002

🤝 B2B

🏢 Enterprise

💸 Finance

B2B • Enterprise • Finance

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

• Review the claims denied and carry out the appeals process appropriately and in a timely manner. • Identify and work denials, responding to the denial reason and resubmitting any information needed to the payor. • Work denials and appeals timely, evaluating the denial reason including information from the payor and payor policies, reviewing the clinical documentation, assessing options and completing next steps. • Submit retro-authorizations in accordance with payor requirements in response to authorization denials. • Conduct medical necessity reviews, based on denial root cause, and prepare any required clinical documentation summaries to accompany appeals. • Write and submit written appeals which include compelling arguments based on clinical documentation, third-party payer medical policies, and contract language. • Document all actions taken and follow-up timely as needed related to resolving denials and appeals with third-party payers in a timely manner. • Track the status and progress of denials and appeals. • Identify denial patterns and escalate to management as appropriate with sufficient information for additional follow-up, and/or root cause resolution.

🎯 Requirements

• Clinical Appeals Experience: At least 1 year of clinical appeal writing experience. • Clinical Experience: Minimum of 3-5 years acute care clinical experience in a hospital setting (Med/Surg, or similar preferred); 2-3 years if ICU experience. • Education: Bachelor of Science in Nursing. • Licensure: Must be Registered Nurse with an active USRN license. • RCM Knowledge: Proficiency in using InterQual or MCG clinical guidelines. • Broad Knowledge of U.S. Government Programs and Insurance Regulations. • Software Knowledge: Proficiency with hospital-based electronic medical records (EMR) such as Epic, Cerner, or Meditech.

🏖️ Benefits

• medical, dental and vision coverage • 401(k) plan with a generous employer match • employee stock purchase plan • generous Paid Time Off policy • paid parental leave and adoption assistance • Wellness Program supports employee total well-being by providing free annual health screenings and coaching, bank at work, and on-site workshops • ongoing programs recognizing major events in the lives of our employees throughout the year