Nurse Auditor Reviewer

Phelps Health is a 2000-employee-strong hospital and healthcare system serving the heart of small-town Missouri.

No matter where you start with us, we’re committed to taking our team to the top. If you’re ready for the challenge of providing life-saving care or supporting those who do, read on to find your fit in the Phelps Health family.

General Summary

• This position supports the Denial, Prevention, and Recovery Department (DPR) by providing Clinical Data Analyst and Review services. The Nurse Auditor performs appeal writing, reviews, and other tasks that may be assigned by the Denial and Prevention Director. Also serves as a contact person/liaison between auditors/external resources. Evaluates trends in denials, high risk areas and provides education.

Essential Duties and Responsibilities

• Retrieves patient medical records to compile all requested documentation in the format stipulated and within the timeframe requested by CMS.
• Tracks audit requests/appeals/due dates/correspondence and communicates with payer/auditor.
• Compiles and presents reports on behalf of the Denial & Prevention Department.
• Writes appeals, works with providers to obtain letters of medical necessity for appeal work, reviews records for medical necessity.
• Manages departmental correspondence, mail, and tracking spreadsheets.
• Cross trains to other roles within the department, in particular insurance review and case management.
• Develops front end education and training to related denials.

Education

• Graduate of an accredited Associates or Bachelor’s Nursing program required. Training in Microsoft EXCEL highly preferred.

Work Experience

• At least 3 years of clinical experience. Experience with utilization management, disccharge planning, and third party payors preferred. Must be computer literate and have knowledge and understanding of psycho/social needs.

Certification/License

• Missouri or Compact State RN Licensure required.
• Case Management certification preferred.

Mental/Physical Requirements

• Considerable mental concentration. Ability to receive and express detailed information through oral and written communications. Excellent interpersonal and organizational skills.

Working Conditions

• hybrid remote work
• must be able to work collaboratively with stakeholders, speaking in public at times

At Phelps Health, we think we have a better team, benefits, and opportunities for growth than anyone else around, and we invite you to see for yourself! Apply now to join us on our mission in health care.