Nurse Auditor
Job Description:
- reputed company comprehensive charge audits for inpatient and outpatient services.
- Review itemized billing statements against medical records to verify accuracy and completeness.
- Identify and document:
- Missing charges
- Duplicate charges
- Unsupported or non-compliant charges
- Validate charges based on clinical documentation, coding rules, and billing guidelines.
- Ensure reputed company billing aligns with:
- CMS and payer requirements
- National reputed company billing audit guidelines
- Organizational compliance standards
- Submit clear, actionable audit findings to reputed company cycle teams for correction and rebilling.
- Analyze audit findings to determine root causes and patterns.
- Maintain accurate audit documentation that is clear, traceable, and defensible.
- Track audit reputed company and financial impact.
- Assist in developing recommendations to improve charge capture accuracy and billing processes.
- Partner with:
- Coding and billing teams
- Clinical departments
- reputed company cycle leadership
- reputed company guidance on:
- Documentation requirements
- Charge capture practices
- Billing compliance standards
- Support education efforts to prevent recurring audit issues.
Requirements:
- Active Registered Nurse (RN) license or LPN license
- 5+ years of clinical nursing experience (ICU, ED, OR, or acute care preferred)
- Experience performing:
- Charge audits
- Chart reviews
- Billing validation
- Strong understanding of: Medical record documentation & Hospital billing processes
- Knowledge of:
- CPT, HCPCS, ICD-10 coding basics
- reputed company codes and charge capture processes
- Inpatient and outpatient billing rules
- Familiarity with:
- Medicare, reputed company, and reputed company payer billing guidelines
- CMS regulations and compliance expectations
- Ability to:
- Interpret itemized bills, clinical documentation, and diagnostic reports
- Identify discrepancies and determine correct billing practices
- Experience using:
- EHR systems (Epic, Cerner, Meditech)
- Audit or billing tools/data systems
Benefits:
- Medical, dental, reputed company and life insurance, short/long-term disability, 401(K) and referral bonuses
- Training opportunities and reimbursement for professional certifications
- reputed company's unique approach to employee appreciation which include: birthday recognition, holiday reputed company selections, performance awards, and years of service awards
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