Clinical Nurse Auditor
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Job Location:
Charlotte, VT - USA
Monthly Salary:
$ 70500 - 150800
Posted on:
20 days ago
Vacancies:
1 Vacancy
Job Summary
Position Description:
The Clinical Nurse Auditor is a member of the CGI CSG Clinical Audit Team with responsibility for reviewing medical records to determine the medical appropriateness in a variety of care settings for clinical services rendered to beneficiaries of various health plans including Commercial and Government Clients. The Clinical Nurse Auditor is charged with rendering independent appropriate well-supported and thoroughly-documented decisions which may result in identification of improper payments on paid claims on behalf of the Client from various Providers of clinical services including but not limited to acute care outpatient and other Provider types and care settings. The Clinical Nurse Auditor is prepared for the role through a detailed well-defined training process gaining knowledge and skills in methods for review of the medical record and other provider documentation application of appropriate screening guidelines and use of the documentation format tailored to the Clients requirements. Ongoing training and education are provided specific to audit processes clinical procedures disease states and other topics as indicated. The review process may result in approval or denial of payment for previously-rendered services and decisions are rendered through a well-defined process which requires the Auditor to incorporate clinical experience knowledge and critical thinking skills in order to assess available information and render a decision. The Clinical Nurse Auditor reports to a Clinical Audit Team Leader who provides support feedback and guidance to the Auditor. Audit performance review inter-rater reliability (IRR) and performance measurement (PM) are performed through a well-defined review and quality management program.. This position can be located remotely anywhere in the U.S and candidates must be willing to work in Eastern Time Zone hours.
Your future duties and responsibilities:
. Conducts inpatient and outpatient claim audits to determine medical necessity/reasonable and necessary services validation of prior authorization clinical validation medical service charge audit or other audit types as required thereby recovering improper payments when it is determined through the audit process that the medical record does not support the services billed. Other types of audits may be performed as required by the Client.. Develops rationale for the audit decision based on the providers submitted information citing appropriate review guidelines applicable regulations and/or internal review guidelines and enters clearly documented information in ProperPay. Follows the designated procedure for referral to a Physician Advisor if required by Client contract.. For Clinical Validation audits documents specified coding issues in conjunction with the DRG Validation Team as assigned.. Follows CGI CSG policies and processes completing mandatory training timesheets payroll travel expense documents and other corporate requirements in a timely manner.. Communicates timely with Team Lead required regarding illness appointments vacation requests changes in work schedule performance barriers and computer issues.. Complies with department standards regarding productivity and audit quality.. Performs other duties as assigned
Required qualifications to be successful in this role:
. The Clinical Nurse Auditor is a Registered Nurse with active unrestricted licensure through the Board or Agency charged with providing such licensure in the Auditors state of residence.. Intensive Care nursing experience of five or more years is required.. A strong working knowledge of computer functions Microsoft Office (Outlook Word Excel) applications and Windows operating systems is required in order to manage audit processes.. The clinical nurse auditor utilizes skills to write a well-reasoned review in narrative style with accurate spelling grammar punctuation and sentence structure.. The Auditor must be able to work independently adapt to changing priorities and meet department productivity standards and deadlines.. The Auditor may be required to travel as much as 25% of the time for additional training and on-site reviews on an as-needed set Years of experience:ICU/CCU Nursing experience5-10 years
Other Information:
CGI is required by law in some jurisdictions to include a reasonable estimate of the compensation range for this role. The determination of this range includes various factors not limited to skill set level experience relevant training and licensure and certifications. To support the ability to reward for merit-based performance CGI typically does not hire individuals at or near the top of the range for their role. Compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range for this role in the U.S. is $70500.00 - $150800.00.
CGIs benefits are offered to eligible professionals on their first day of employment to include:
. Competitive compensation
. Comprehensive insurance options
. Matching contributions through the 401(k) plan and the share purchase plan
. Paid time off for vacation holidays and sick time
. Paid parental leave
.Learning opportunities and tuition assistance
. Wellness and Well-being programs
What you can expect from us:
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Life at CGI is rooted in ownership teamwork respect and belonging. Here youll reach your full potential because
You are invited to be an owner from day 1 as we work together to bring our Dream to life. Thats why we call ourselves CGI Partners rather than employees. We benefit from our collective success and actively shape our companys strategy and direction.
Your work creates value. Youll develop innovative solutions and build relationships with teammates and clients while accessing global capabilities to scale your ideas embrace new opportunities and benefit from expansive industry and technology expertise.
Youll shape your career by joining a company built to grow and last. Youll be supported by leaders who care about your health and well-being and provide you with opportunities to deepen your skills and broaden your horizons.
Come join our teamone of the largest IT and business consulting services firms in the world.
Qualified applicants will receive consideration for employment without regard to their race ethnicity ancestry color sex religion creed age national origin citizenship status disability pregnancy medical condition military and veteran status marital status sexual orientation or perceived sexual orientation gender gender identity and gender expression familial status or responsibilities reproductive health decisions political affiliation genetic information height weight or any other legally protected status or characteristics to the extent required by applicable federal state and/or local laws where we do business.
CGI provides reasonable accommodations to qualified individuals with disabilities. If you need an accommodation to apply for a job in the U.S. please email the CGI U.S. Employment Compliance mailbox at . You will need to reference the Position ID of the position in which you are interested. Your message will be routed to the appropriate recruiter who will assist you. Please note this email address is only to be used for those individuals who need an accommodation to apply for a job. Emails for any other reason or those that do not include a Position ID will not be returned.
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All CGI offers of employment in the U.S. are contingent upon the ability to successfully complete a background investigation. Background investigation components can vary dependent upon specific assignment and/or level of US government security clearance held. Dependent upon role and/or federal government security clearance requirements and in accordance with applicable laws some background investigations may include a credit check. CGI will consider for employment qualified applicants with arrests and conviction records in accordance with all local regulations and ordinances.
CGI will not discharge or in any other manner discriminate against employees or applicants because they have inquired about discussed or disclosed their own pay or the pay of another employee or applicant. However employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information unless the disclosure is (a) in response to a formal complaint or charge (b) in furtherance of an investigation proceeding hearing or action including an investigation conducted by the employer or (c) consistent with CGIs legal duty to furnish information.
Key Skills
- Auditing
- Time Management
- ICD-10
- Accounting
- Component evaluation
- Workers' Compensation Law
- SOX
- Microsoft Excel
- CPT Coding
- Internal Audits
- Medicare
- Bookkeeping
About Company
The COMPANY is one of the few end-to-end consulting firms with the scale, reach, capabilities and commitment to meet clients’ enterprise digital transformation needs. Our 77,500 consultants and professionals work side-by-side with clients in 10 industries across more than 400 location ... View more
