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Career Opportunities

Medical Auditor Registered Nurse (RN) Full Time Day Shift near Valdosta, GA

Job Title
Medical Auditor Registered Nurse (RN) Full Time Day Shift near Valdosta, GA
Job ID
27240981
Location
Valdosta,  GA
Other Location
Description

POSITION SUMMARY

Ensures that payers are prepared to reimburse the South Georgia Health System for scheduled services in accordance with the payer-provider contract, and works diligently toward the identification, mitigation, and prevention of clinical denials. In addition to contacting payers and providers to secure authorizations, this staff member uses their clinical expertise while reviewing clinical denials to determine next steps. Conducts appeals as appropriate by reviewing medical necessity, responding to authorization concerns, and/or reconciling coverage-related issues.  Coordinates Medicare RAC and TPE activities.

KNOWLEDGE, SKILLS & ABILITIES

  • Registered nurse (RN) licensure required, bachelor's degree in nursing preferred. Certification in at least one of the following preferred: certified healthcare chart auditor, certified professional in utilization review (or utilization management or healthcare management), certified case manager, certified documentation specialist, certified coder, certified professional medical auditor, or similar program.
  • A minimum of 5 years acute care experience working as an RN required.  Hospital experience within the past 2 years.  Case management experience preferred.
  • Familiarity with National Coverage Determinations and Local Coverage Determinations. Proficient in medical terminology and able to interpret patient medical records.
  • Knowledge of medical necessity screening criteria (e.g., Milliman, InterQual).
  • Proficient in EHR and other systems used by organization. Strong time management and prioritization skills.
  • Excellent communication and customer service with patients and staff.
  • Strong attention to detail.

For more details please contact Kara.Gist@sgmc.org

Required Skills

Registered nurse (RN) licensure required, bachelor's degree in nursing preferred. Certification in at least one of the following preferred: certified healthcare chart auditor, certified professional in utilization review (or utilization management or healthcare management), certified case manager, certified documentation specialist, certified coder, certified professional medical auditor, or similar program.
A minimum of 5 years acute care experience working as an RN required. Hospital experience within the past 2 years. Case management experience preferred.
Familiarity with National Coverage Determinations and Local Coverage Determinations. Proficient in medical terminology and able to interpret patient medical records.
Knowledge of medical necessity screening criteria (e.g., Milliman, InterQual).
Proficient in EHR and other systems used by organization. Strong time management and prioritization skills.
Excellent communication and customer service with patients and staff.
Strong attention to detail.

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