Huron
Clinical Denials Auditor
Chicago - 550 Van Buren
Sponsorship not specified$80k-$105kDetected 20 days ago
Stakeholder ManagementExcelAuditingEpicCernerEHR/EMRLeadershipCollaborationMentoringPublic SpeakingMicrosoft OfficeSharePoint
About the role
- Health systems, hospitals and medical clinics are under immense pressure to improve clinical outcomes and reduce the cost of providing patient care.
- The Auditor assists Utilization and Denials management in preparing daily operational reports, provide QA (quality assurance) feedback, and participate in the client interactions and internal stakeholder meetings.
- Conducts monthly team meetings and annual performance evaluations with team members.
Responsibilities
- Assists in QA program build, including advising on the most critical aspects of the workflow/accounts to audit, attributes of an effective audit program, and how to leverage automation/efficiency tools
Requirements
- Licensure: Must be Registered Nurse and with active USRN license.
- RCM Knowledge: Proficiency in using InterQual or MCG clinical guidelines.
- Broad Knowledge of U.S. Government Programs and Insurance Regulations
- Associate Degree in Nursing (ADN) or Diploma in Nursing.
- Must be Registered Nurse and with active USRN license.
- Proficiency in using InterQual or MCG clinical guidelines.
Nice to have
- Credential/Certification: Case management or clinical appeals or clinical denials certification (ACMA) is preferred.
- Software Knowledge: Proficiency with using computer programs for tracking authorization, and/or denials and appeals.
- Proficiency with Microsoft office suite (Excel, Word, PowerPoint, Outlook, SharePoint)
- Additional Job Description
- The range represents a good faith estimate of the range that Huron reasonably expects to pay for this job at the time of the job posting.
- United States of America
- Minimum of 3-5 years acute care clinical experience in a hospital setting (Med/Surg, or similar preferred)
- 2-3 years if ICU experience.
Compensation
- Conducts monthly team meetings and annual performance evaluations with team members.
Benefits
- Demonstrates domain expertise in quality process related to meeting production schedules and the documentation of medical diagnoses and treatment practices
- Monitors and maintains team QA records and auditing/education findings for Utilization and Denials Management staff.
- Partner with global Operations, Training, and HR to streamline onboarding and on-the-job learning (OJL).
This listing is sourced directly from Huron's careers page and normalized into a canonical job model.