Job Description

We offer complex facility claim audit services to our national health plan clients. They utilize our clinical based specialty oriented services to ensure high cost hospital claims are reviewed and paid based on industry standard charge guidelines and covered plan benefits.

Based on review of the patient’s clinical record, the Specialist analyzes complex hospitalizations and investigates facility care charges for recommended payment adjustments based on the following key areas:

· Room and board acuity

· Incidental supplies and nursing services

· Preventable hospital acquired conditions

· Investigational pharmaceuticals and other therapies

Key skill sets include:

· Advanced nursing degree with recent clinical experience

· Clinical claim review experience including trauma, ICU, NICU, transplant, oncology, cardiac and pediatrics

· Critical thinking and non-standardized approaches to clinical issues and problem solving

· Highly flexible and intellectually curious

· Excellent organization, writing and communication skills

· Self-starter

We offer an industry leading compensation and benefits package. A flexible office or work from home environment is available.