Audit Reviewer, RN/CPC

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🏈 Alabama, Arizona, +17 more states – Remote

🏈 Alabama – Remote 🌵 Arizona – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌪️ Kansas – Remote 🦞 Maine – Remote 🌶️ New Mexico – Remote 🌲 North Carolina – Remote 🌪️ Oklahoma – Remote 🚗 Michigan – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote 🌴 South Carolina – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⚔️ Virginia – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Knowtion Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2008

⚕️ Healthcare Insurance

💳 Fintech

☁️ SaaS

💰 Private Equity Round on 2020-09

Healthcare Insurance • Fintech • SaaS

Knowtion Health is a company that assists hospitals in handling denied and complex claims, recovering low balance accounts, and providing defense against payer audits. By leveraging advanced technology and a team of experts, Knowtion Health aims to maximize revenue and improve patient experiences. Their services include addressing clinical denials and managing various challenging payer classes, positioning them as a strong advocate for their clients in the healthcare sector.

📋 Description

• Reviews medical record documentation to verify clinical indicators and coding issues as related to DRG Validation Audits, Emergency Department Downgrade Audits, Inpatient Level of Care Audits, and Charge Outlier Audits, etc. • Creates detailed appeal letters for denials from payer to support payment of patient claims • Manages Inventory and Follow up on accounts as appropriate • Reviews InterQual/Milliman, coding guidelines and/or payer medical policies related to denied procedures or services and includes criteria in appeals letter as appropriate • Provides feedback to supervisor regarding issues identified for ongoing training to peers and non-clinical staff members • Identifies root causes and trends to share with clients and staff • Works with peers in collaboration of clinical writing situations

🎯 Requirements

• Current and valid RN License or Coder with 3 years inpatient experience • Two years of experience in an acute care hospital (Med/Surg) preferred • Five years of experience in clinical medical record audits or coding preferred • Experience using InterQual and Milliman healthcare criteria preferred • Experience reviewing CMS LCD/NCD criteria preferred • Knowledge of CMS and payer reimbursement guidelines preferred • Knowledge of DRG, ICD-10, CPT and HCPCS codes preferred • Comfort with productivity standards

🏖️ Benefits

• medical • dental • vision • life insurance • short term disability • long term disability • bonus opportunities • paid holidays • 401k • generous PTO policy