Note: The job is a remote job and is open to candidates in USA. Trend Health Partners is a tech-enabled payment integrity company focused on improving access to healthcare through collaboration between payers and providers. The Nurse Auditor I is responsible for performing medical necessity reviews of clinical documentation to ensure compliance with contracts, policies, and regulations.
Responsibilities
- Independently audit clinical documentation to ensure consistent with billed services in a production environment
- Apply clinical and industry guidelines, payer P&P, and use of in-depth knowledge that supports medically necessity of services rendered
- Develop relationships with medical providers and health plans to confirm adherence to P&P, guidelines, and continuum of care
- Continually keep abreast of technology changes, regulatory issues, and medical practice through ongoing training and self-directed research and share with others, accordingly
- Share ideas that offer process improvements and share with team for education
Skills
- An active RN or LPN professional license in good standing
- 5 years of clinical practice
- Well-developed verbal and written communication skills coupled with recognizable organization
- Ability to effectively prioritize tasks
- Previous experience in medical auditing
- Experience in auditing or medical review
- Case Management and/or Utilization Review experience
- Experience in utilizing industry clinical guidelines
Benefits
- Competitive salaries
- Highly valued health insurance
- A 401(k) plan with employer match
- Paid parental leave
Company Overview