Clinical Denials Auditor
Core
Audit utilization management and clinical denials/appeals workflows to ensure accuracy and productivity for healthcare clients.
Role type
Senior IC clinical denials auditor (QA & operations)
Builds
Production reports, QA feedback loops, and audit findings for healthcare organizations
Domain
Healthcare administration / Utilization management / Clinical denials
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Utilization management auditing, Clinical appeals writing QA, Acute care clinical experience, Registered Nurse licensure, InterQual/MCG guidelines, EMR systems (Epic/Cerner/Meditech)
Preferred skills
BSN degree, Case management certification, Denials tracking software, Microsoft Office suite
Technologies
Epic, Cerner, Meditech, InterQual, MCG
Responsibilities
Monitor staff performance metrics for productivity and accuracy, Escalate production/QA roadblocks to management, Provide training and coaching to team members, Maintain team QA records and audit findings, Conduct monthly team meetings and annual performance evaluations, Present training dashboards to clients
Seniority
Associate, hands-on IC