Project Nurse Auditor PHX
THIS JOB HAS EXPIRED Description
Are you looking for a new challenge in a corporate environment? Do you want to be part of an award-winning team? PHX has been recognized as one of the Best Places to Work in 2013 and one of the fastest growing companies by NJBiz and Inc. Magazine.
Due to new business needs, we are seeing 2 new Project Nurse Auditors to support one of our newest clients. These nurses will be responsible for conducting in-depth audit for billing, coding, or payment errors/overpayments as well as review of facility bills as it compares with medical records and coverage policies.
Work closely with Audit Coordinator in all aspects of claim analysis for Client-specific claims including but not limited to medical record review, overall claim review, etc.
Assist with the Claims Selection Process for audit.
Review Medical Coverage Policies and Coverage Determinations
Review itemized bill and medical records for medical appropriateness and inconsistencies by performing a line by line clinical review of claim.
Research unfamiliar procedures as needed via web.
Research high-cost pharmaceutical products utilizing all applicable tools and software.
Present recommended findings including all supportive documentation and saving recommendations to client.
Prepare management reports of findings
LPN license or RN
2 + years of clinical auditing experience or case management or utilization review
2+ years of pharmaceutical experience and/or exposure to high-cost therapeutic areas such as oncology, specialty infusion, etc.
Excellent written and verbal communication skills
Exceptional organizational skills
||Bedminster, NJ |
THIS JOB HAS EXPIRED