Claims Auditor LVN

LSMA Management Inc • San Bernardino, CA

2d • Onsite

About The Position

The Claims Auditor LVN is responsible for retrospective review and audit of medical claims to ensure services billed are medically necessary, properly authorized, supported by medical documentation, and compliant with contract terms, regulatory requirements, and evidence-based clinical criteria. This role supports the Claims and Utilization Management departments by identifying billing discrepancies, overutilization trends, and opportunities for process improvement while maintaining strict confidentiality and regulatory compliance.

Requirements

• Graduate of an accredited Licensed Vocational Nursing Program.
• 2+ years of clinical LVN experience.
• 1+ years of utilization review, claims review, or managed care experience.
• Current State LVN License
• Knowledge of medical terminology, clinical documentation standards, and nursing principles applicable to utilization review
• Working knowledge of Medicare, Medi-Cal, managed care regulations, and health plan rules
• Familiarity with clinical review criteria such as InterQual and/or Milliman/MCG
• Strong analytical, organizational, and documentation skills
• Ability to communicate clearly and professionally, both verbally and in writing
• Basic to intermediate computer skills and ability to work within claims and electronic medical record systems
• Ability to work independently in a fast-paced, deadline-driven environment

Nice To Haves

• Additional coursework or training in utilization management, case management, or healthcare compliance.
• Experience in claims auditing, Stop Loss review, or health plan operations.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed