[Hiring] Clinical Denials Auditor @Huron

Role Description

The Utilization and Denials Management Auditor is responsible for the day-to-day production and quality functions of a team of Utilization and Denials Management specialists specializing in meeting client production goals and accuracy goals. The Auditor assists Utilization and Denials management in preparing daily operational reports, providing QA (quality assurance) feedback, and participating in client interactions and internal stakeholder meetings.

Key Responsibilities:

• Quality Assurance (QA) & Delivery:
  • Assists in QA program build, including advising on critical aspects of the workflow/accounts to audit.
  • Monitors performance of all Utilization and Denials Management staff using key metrics.
  • Escalates Production and QA concerns or roadblocks to the Manager as needed.
  • Demonstrates domain expertise in quality processes related to meeting production schedules.
  • Deep understanding of both production and quality assurance Utilization and Denials Management processes.
• QA Administration & Documentation:
  • Experience providing training, coaching, and development to team members.
  • Monitors and maintains team QA records and auditing/education findings.
  • Completes special projects, such as full Utilization and Denials Management audits.
  • Mentors staff to maximize performance and potential.
  • Assists in maintaining and monitoring team members' job satisfaction and morale.
• Performance & Evaluation:
  • Reviews production and quality accuracy reporting for all assigned projects.
  • Motivates team members through effective training and coaching.
  • Conducts monthly team meetings and annual performance evaluations.
• Collaboration & Stakeholder Management:
  • Partners with global Operations, Training, and HR to streamline onboarding.
  • Participates in client calibration calls to align training KPIs with operational metrics.
  • Supports client visits, internal audits, and process reviews.
  • Other duties and responsibilities as assigned.

Qualifications

• Required Qualifications:
  • QA Experience: At least 1 year of Utilization management and/or Clinical appeals writing QA or auditing experience in a healthcare setting.
  • Clinical Experience: Minimum of 3-5 years acute care clinical experience in a hospital setting (Med/Surg, or similar preferred); 2-3 years if ICU experience.
  • Education: Associate Degree in Nursing (ADN) or Diploma in Nursing.
  • Licensure: Must be Registered Nurse with an active USRN license.
  • RCM Knowledge: Proficiency in using InterQual or MCG clinical guidelines.
  • Software Knowledge: Proficiency with hospital-based electronic medical records (EMR) such as Epic, Cerner, or Meditech.
• Preferred Qualifications:
  • Education: Science in Nursing (BSN) preferred.
  • Credential/Certification: Case management or clinical appeals or clinical denials certification (ACMA) is preferred.
  • Software Knowledge: Proficiency with using computer programs for tracking authorization, and/or denials and appeals. Proficiency with Microsoft Office Suite (Excel, Word, PowerPoint, Outlook, SharePoint).

Benefits

• The estimated base salary range for this job is $80,000 - $105,000.
• The job is also eligible to participate in Huron’s benefit plans which include medical, dental and vision coverage and other wellness programs.