Premier Medical Resources

The Clinical Pre-Service Nurse Auditor applies clinical judgment and utilization management principles to review upcoming procedures, ensuring insurance and medical necessity requirements are met prior to service delivery. This involves securing payer authorizations, verifying clinical documentation, and communicating with clinical staff regarding necessary actions or potential rescheduling.

The Medical Coder is responsible for reviewing medical documentation and accurately assigning CPT, ICD-10-CM, HCPCS, and/or ICD-10-PCS codes based on the encounter type to ensure accurate billing and optimized reimbursement in outpatient and/or facility settings. Essential functions include assigning codes, reviewing documentation for support, applying proper modifiers and sequencing, and ensuring compliance with regulations.