Defense Auditor

MCG Health Inc Augusta, GA
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Defense Auditor

Work Location:Augusta University Medical CenterReq Number:16968 Department Name:5222 Revenue IntegrityShift:DayPosition Status:Full TimeEmployment Status:Regular

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Position Description

Works collaboratively with team members of the Revenue Cycle to review clinical and financial information on patients' accounts to resolve billing edits, provide feedback on medical necessity and generate appeal letters. Engages with payer representatives to review cases and defend charges as necessary. Engages in performance improvement initiatives and works collaboratively with members of the health system and clinical department staff to ensure accuracy of charges on patient accounts.

Position Requirements

Bachelor's Degree in Nursing required. Three years of experience in a clinical setting. Two years of experience in utilization review or care facilitation management. Licensed to practice as Professional Registered Nurse in the State of Georgia or have an active Multi-State Registered Nurse Compact License.

Preferred Requirements

Experience with utilization review and/or insurance precertification authorizati