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    Senior Tax Manager - Tulsa, United States - Inceed

    Inceed
    Inceed Tulsa, United States

    3 days ago

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    Description

    Clinical Denials Quality Auditor

    Are you ready for your next challenge? Join the team at Virtual Business Office Associates, where you'll find a dynamic and expanding workforce that still retains that homely feel. We are looking for A/R Specialists who have expertise in handling denied claims from start to finish to become a part of our top-notch KLAS Extended Business Office.

    About the Company:
    The Virtual Business Office Associates is a warm and diverse workplace that offers ample room for growth and development. We are proud to be one of the largest professional services firms globally, providing you with access to cutting-edge automation and AI technologies to enhance your professional journey. Join us for a stable career opportunity, a flexible schedule allowing you to maintain a healthy work-life balance, and a host of employee benefits.

    Hiring remotely from:
    FL, GA, TX, NC, SC, VA, KY, AL

    FLSA Status:
    Exempt

    What's in it for you:

    • Gain valuable experience in a fast-paced, diverse, and inclusive work environment
    • Endless opportunities for professional growth and development
    • Access to advanced EMR systems and full portal access for efficient work processes
    • Enjoy a permanent position with stability and growth prospects
    • Flexible schedules promoting work-life balance, including early Fridays off
    • Comprehensive employee benefits package

    Responsibilities:

    • Conduct audit reviews on medical necessity appeals to ensure compliance with client requirements
    • Utilize audit tools to perform documentation audits within the Clinical Audit department
    • Manage audit tasks for various clients and report on departmental functions
    • Collaborate with IT for necessary report modifications for tracking clinical denials appeals
    • Utilize evidence-based guidelines for making clinical decisions and achieving business results

    Requirements:

    • License/Certification: RN
      Registered Nurse with a Bachelor of Science in Nursing
    • Experience in auditing and root cause analysis
    • Knowledge of payer appeal and grievance regulatory requirements
    • 3-5 years of acute care experience
    • 5+ years in healthcare with managed care, hospital, or physician practice settings
    • 3+ years in managed care with 2 years in Utilization Management
    • Training or experience in utilization review, discharge planning, and case management
    • Experience with Interqual, MCG, CMS LCD, and NCD's
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