paycor

Nurse Auditor

Elevate Patient Financial Solutions

Remote, USA

Full-time

Mid

Remote

Discovered 2 weeks ago

InterQualMCG

Full Job Posting

Authorization Denials
Prepare a clinical reconsideration/appeal letter to submit to the payer based on the evidence in the patient’s medical records to justify either an acute level of care or skilled level of care (based on results from either MCG or InterQual review).
Medical Necessity Denial Reviews
Prepare a clinical reconsideration/appeal letter to submit to the payer based on the evidence in the patients’ medical records that supports the necessity for denied services.
Other Denial Reviews for Appeal:
DRG Downgrades
MAC & RAC Audits
Payer Utilization Review Audits
Experimental Procedures
Charge Audits
Other duties as assigned.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or abilities.
Utilization Review
Case Management
Preparing and submitting Authorizations
Use of InterQual and/or MCG
Inpatient Clinical Experience
Registered Nurse; or
Licensed Vocational Nurse
Remote and Hybrid positions require a home internet connection that meets the company’s upload and download speed criteria.

ElevatePFS believes in making a positive impact not only within our industry but also with our employees –the organization’s greatest asset! We take pride in offering comprehensive benefits in a vast array of plans that contribute to the present and future well-being of our employees and their families.
Medical, Dental & Vision Insurance
401K (100% match for the first 3% & 50% match for the next 2%)
15 days of PTO
7 paid Holidays
2 Floating holidays
1 Elevate Day (floating holiday)
Pet Insurance
Employee referral bonus program
Teamwork: We believe in teamwork and having fun together
Career Growth: Gain great experience to promote to higher roles
The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, location, specialty and training. This pay scale is not a promise of a particular wage. The job description does not constitute an employment agreement between the employer and Employee and is subject to change by the employer as the needs of the employer and requirements of the job change. ElevatePFS is an Equal Opportunity Employer

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