RN Clinical Auditor in Anchorage, AK

A company is looking for a RN-Clinical Auditor 2. Key Responsibilities Performs audits of medical records for denials review, defense audits, disallowed charges, and utilization reviews Completes analysis of records against established criteria to determine compliance with patient care standards Organizes and prioritizes multiple cases while maintaining confidentiality and adhering to HIPAA guidelines Required Qualifications Must be RN / Case Management / Utilization Review / Coding certified with a BS / BA preferred or equivalent experience 3 to 5 years of clinical or clinical auditing experience in case management, Medicare appeals, or denials management Knowledge of Milliman (MCG) or InterQual criteria preferred Experience in medical records review, claims processing, or utilization / case management Proficiency in Microsoft Outlook, Word, Excel, and electronic documentation systems