Nurse Auditor - Hospital Bill and Medical Claims Review

Position Summary: National Healthcare Claims Auditing company seeks Field Nurse Reviewer to perform on-site hospital bill audits as well as desk reviews.  These audits include the validation of medical services ordered, performed and subsequently billed. 

 

 

General Description:

·  Adhere to National Audit’s conduct code and professional performance standards

·  Adhere to all National Audit policies and procedures as described in the National Audit Employee Handbook

·  Assume responsibility for job performance

·  Maintain strict confidentiality of member medical information and records

·  Comply with National Audit HIPAA requirements

·  Prepare and maintain reports as required

·  Perform other duties as required

 

Position Responsibilities:

·  Audit medical records to verify the services were provided and charges are accurate

Ø Identify and document both over charges and under charges

Ø Identify and document all unbilled charges

·  Maintain timely communication with Audit Coordinators regarding:

Ø Scheduling of audits

Ø Completion of audits

Ø Audit related issues

Ø Submission of all exited audit documents

·  Report problems to the responsible Program Manager or Supervisor

·  Compile concise records and documentation of all audits performed

·  Identify and communicate facility and provider specific issues that will impact audits

·  Monitor facility profile for assigned facilities

Education / Skill Requirements

 

·  RN or LPN, maintains current licensure

·  Has a minimum of 5 years diverse clinical experience

·  Previous auditing experience preferred

·  CPC, CCS or CMAS desired