Clinical Auditor

Job Summary:

The Clinical Auditor will be responsible for conducting in-depth reviews of medical claims to ensure compliance with accepted medical guidelines and clinical criteria. This role requires a strong understanding of audit techniques, identification of revenue opportunities, and financial negotiation with providers. The ideal candidate will have 3-5 years of experience in auditing, claims review, and/or billing with a healthcare organization.

Key Responsibilities:

Conduct thorough reviews of medical claims to identify potential revenue opportunities
Collaborate with providers to negotiate financial settlements
Develop and implement audit plans to ensure compliance with regulatory requirements
Analyze data to identify trends and areas for improvement

Requirements:

RN or LPN required
3-5 years of experience in auditing, claims review, and/or billing with a healthcare organization
Strong understanding of audit techniques and financial negotiation
Excellent written and verbal communication skills

What We Offer:

Zelis Healthcare is a leading provider of healthcare financial solutions. We offer a dynamic and supportive work environment, competitive compensation and benefits package, and opportunities for professional growth and development. If you are a motivated and detail-oriented individual with a passion for healthcare, we encourage you to apply for this exciting opportunity.

Why Join Zelis Healthcare?

At Zelis Healthcare, we are committed to delivering innovative solutions that improve the healthcare financial experience. Our team of experts is dedicated to helping payers, providers, and healthcare consumers navigate the complex healthcare system. We offer a collaborative and inclusive work environment that values diversity, equity, and inclusion. If you are looking for a challenging and rewarding career opportunity, we encourage you to join our team.

Equal Employment Opportunity:

Zelis Healthcare is an equal opportunity employer. We welcome applications from diverse candidates and are committed to creating an inclusive work environment. We do not discriminate on the basis of race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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