A healthcare solutions company in New Jersey is seeking a talented and driven professional with a demonstrated background dealing with clinical auditing and case management, to take on a role as the Assistant Director of Bill Review & Audit. This is a fantastic opportunity for a qualified candidate to bring their knowledge, skill set, and work ethic to this dynamic company! Please submit your resume for immediate consideration today.

Healthcare Solutions Company

The Nurse Auditor will maintain a professional communication flow with medical providers, and conduct in-depth review of facility bills as it compares with medical diagnosis and usage.

Key responsibilities:

• Review daily in-process report for new assigned claims
• Request documentation from Office Assistant needed to complete clinical review of assigned claims
• Review coding of professional bills utilizing requested procedural notes
• Review itemized bill and medical records for medical appropriateness and inconsistencies by performing a line by line clinical review of claim
• Research unfamiliar procedures as needed via web
• Contact provider's representative to resolve billing issues
• Contact provider's representative to negotiate claim
• Confirm repricing information with provider
• Provide status of outstanding claims upon request
• Prepare management reports of findings for submission to clients

• 2+ yearsof nursing experience
• LPN or RN
• 2+ years clinical auditing experience or case management
• Strong communication and interpersonal skills
• Strong computer skills
• Utilization Review experience

*