Clinical Denial RN - Clinical Performance - FT - Day
Core
Performs clinical audit and validation of medical records to ensure documentation and diagnosis coding are complete, compliant, and accurate for optimal reimbursement and quality standards.
Role type
Clinical auditor / Registered Nurse (audit)
Builds
Medical claims audit reports and process improvement recommendations
Domain
Healthcare administration / Medical coding compliance
Deliverable
dashboards & analysis
Required skills
Medical record review, Diagnosis coding compliance, Root cause analysis, Change management, Clinical audit criteria application, Database tracking
Preferred skills
CDI experience, Acute care clinical experience
Technologies
Database systems
Responsibilities
Perform prospective and retrospective audits of medical records, Identify root causes of audit findings, Provide clinical interpretation and guidance to auditors, Educate provider services and staff on audit outcomes, Maintain audit result databases for trending, Advise on inappropriate utilization trends
