Healthcare Audit and Appeals Specialist

2 weeks ago


New Orleans, Louisiana, United States LCMC Health Full time
Job Summary

We are seeking a highly skilled and detail-oriented Nurse Auditor and Appeals Coordinator to join our team at LCMC Health. As a key member of our revenue cycle management team, you will play a critical role in ensuring accurate reimbursement and resolving audit and appeal issues.

Key Responsibilities
  • Conduct comprehensive analytical reviews of clinical documentation to determine if an appeal is warranted in a timely manner.
  • Exercise discretion and independent judgment when completing medical record quality audits and preparing appeal arguments.
  • Research and analyze RRLs for government and third-party payer denials, providing supporting documentation for audit and appeal purposes.
  • Collaborate with Compliance, Case Management, Coding, Patient Access, and other departments to resolve audit and appeal trends and issues.
Requirements
  • 5-8 years of experience in healthcare finance, revenue cycle management, patient accounting, and physician billing.
  • Bachelor's Degree in Healthcare (LCMC).
  • Certification as a Certified Professional Coder (CPC) or Certified Coding Specialist (CCS).
Preferred Qualifications
  • Working knowledge of insurance guidelines and experience with case management or utilization review.
  • Electronic health systems experience.
About LCMC Health

LCMC Health is a community-driven healthcare organization dedicated to delivering exceptional care and service to our patients and communities. We value authenticity, originality, equity, inclusion, and a little "come on in" attitude in our culture of everyday extraordinary.

We are an equal opportunity employer and welcome applications from diverse candidates. Please note that incomplete applications may be eliminated due to missing information, and proof of citizenship or immigration status may be required to verify your lawful right to work in the United States.



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