RN - Nurse Auditor - (Tyler, TX)

RN - Nurse Auditor DescriptionResponsible for auditing records to ensure 1st or 2nd level appeals related to medical necessity denials for both private and governmental payors have been submitted timely and with sufficient and accurate records to ensure a favorable outcome.Assists Manager Business Services in departmental denial analysis and provides clinical feedback to help decrease denials. Audits various accounts for accuracy in patient status and authorizations to meet payor specific qualifications.Responsible for obtaining retrospective benefits and authorizations for those scenarios when the patient was not able to provide insurance info at time of service. Works with various insurance companies to provide/complete requests for chart audits as well as patient requested audits.Performs chart audits to ensure compliance with RAC/MIC/MAC/ZPIC requests and any other payor specific takeback situations.Functions as a back-up for Physician one Call (P1C) and financial counselors to review requests for