Remote - PFS Denial Nurse Auditor
About The Position
The PFS Denials Auditor works under the supervision of the manager of PFS Denials. The PFS Denials Auditor is responsible for completing, appealing, tracking, and reporting clinical denial reviews to determine the appropriate actions for post-billing denials. This Individual will combine clinical, financial, and regulatory knowledge and skill to reduce financial risk and exposure caused by payer denials for rendered services. The PFS Denials Auditor has highly developed knowledge and skills in areas of: Medical Necessity, Authorizations, Experimental/Investigational denials, payer audits and filing appeals as well as Government and Non-Government payor requirements with Denial Management.
Requirements
- Clinical knowledge
- Financial knowledge
- Regulatory knowledge
- Knowledge of Medical Necessity
- Knowledge of Authorizations
- Knowledge of Experimental/Investigational denials
- Knowledge of payer audits and filing appeals
- Knowledge of Government and Non-Government payor requirements with Denial Management
Responsibilities
- Completing clinical denial reviews
- Appealing clinical denial reviews
- Tracking clinical denial reviews
- Reporting clinical denial reviews
- Determining appropriate actions for post-billing denials
- Reducing financial risk and exposure caused by payer denials for rendered services
- Applying knowledge of Medical Necessity, Authorizations, Experimental/Investigational denials, payer audits and filing appeals
- Applying knowledge of Government and Non-Government payor requirements with Denial Management
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
