Clinical Denials Specialist (PRN)

United Audit Systems, Inc. (UASI), a rapidly growing healthcare consulting firm seeks to expand its professional team of employees by adding experienced Clinical Appeals Review Nurse to our team. The Clinical Appeals Review Nurse is responsible for completing clinical denial reviews to determine appropriate appeal of patient accounts. The ideal candidate will have a combination of clinical experience in a hospital acute care setting and experience providing reviews of the hospital billing and charging policies.

Primary Responsibilities:

• Completes clinical review of pre- and post-claim denials
• DRG Denials 
• Perform a variety of audit services including charge audit, compliance audit, medical necessity, denials and other requests as needed. Audits may be performed on a concurrent or retrospective basis
• Review and analyze the client inpatient and/or outpatient itemized billing statement and the patient medical record and related documentation to identify items that were not billed correctly.... Click Apply to read the full job description.