Audit inpatient and outpatient medical claims for commercial and government payers, document findings using applicable policies and guidelines, and support appeals when needed. Collaborate on audit improvements, medical policies, provider education, quality assurance, training, and development of review guidelines and system edits. Requires an active, unrestricted RN license in good standing, at least five years of diversified direct-care nursing experience, and at least one year of medical records review experience. Candidates must also have at least one year of claims experience involving coding and medical billing, with utilization review experience strongly preferred.
Machinify provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
