Clinical Audit Process Consultant/RN


Louisville, KY

What you'll be doing

The candidate is responsible to consult with vendors, other areas in PPNO, claims council, claim process organization, legal, SIU and other areas to create additional auditing opportunities. Complete extensive research on CMS/medicaid and other clinical subject matter and write policies for new or existing auditing opportunities. Perform quality audits upon the company current RN. Assist with training for the company RN team. Review audit appeals for internal team and vendors. Perform other job related duties or special projects as assigned.

What your background should be

The candidate should have 5 to 7 years of experience in an acute inpatient hospital setting. 5 to 7 years of medical surgery, surgery, and critical care experience. Knowledge of CMS/medicaid regulations healthcare insurance industry knowledge. Comprehensive knowledge of Microsoft word, excel and access. Health insurance claims knowledge, RACT-CT and/or RNAC cardiology, and ICU or risk management knowledge.

Required Schooling / Training

Bachelor in nursing.

Who is the client company

Client company provides health insurance services.
If you are interested in this position, send your resume to