Home Health Auditor Nurse
Virtual Vocations · Centralia, WA
Job description
Working remotely in a full-time capacity, the Home Health Auditor Nurse will perform medical claims audit reviews, focusing on the Home Health sector, while collaborating with a team to ensure compliance with medical review guidelines and support during the appeals process.Key Responsibilities:Auditing claims for medically appropriate services and documenting findings according to established guidelinesGenerating letters to articulate audit findings and supporting those findings during appeals if necessaryCollaborating with the audit team to identify vulnerabilities and improve audit workflowsRequired Qualifications:Active/unrestricted RN license with an associate or bachelor's degree in nursingMinimum of 2 years of experience in Home Health claims auditing or related fieldsStrong knowledge of ICD-9, ICD-10, CPT-4, or HCPCS codingExperience with utilization management systems or clinical decision-making toolsAbility to work independently and efficiently in a remote environment
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