Nurse Auditor (17332)

Job Description:Perot Systems Corporation is a worldwide provider of information technology services and business solutions to a broad range of clients. We are currently looking for a Nurse Auditor to join our team in Renton, WA. Job Summary:Responsible for assessments of retrospective healthcare utilization, ensuring correct medical coding, and ensuring charge master maintenance. Performs quality audits by examining billing criteria, utilization review standards, and validating charge master functions. Reviews patient accounts to ensure charges are accurate, appropriately coded, and match medical documentation. Represents Patient Financial Services in discussions with commercial insurers on external audit issues. Participates in the evaluation of the quality of charge entry and medical documentation by department personnel and continually seeks opportunities to improve performance and process. Evaluates utilization review criteria to determine the benefit of appealing denied claims. Job Responsibilities: Perform billing and coding audits to ensure charges are supported by appropriate clinical documentation. Ensure that billing and coding complies with Medicare and other payer requirements. Review medical records, following established utilization criteria, for information to support potential grievances of denied charges. Resolve patient’s inquiries concerning charge issues. Refer complicated concerns to Manager. Refer Quality of Care/Risk issue to Risk Manager or designee at specific facility. Establish strong positive communication with patient care departments to assure appropriate and timely charges. Evaluates, communicates, and possibly educates charge-entry results with clinical department director. Ensure education and billing is compliant with Medicare and other payer requirements. Review charge master (CDM) for compliance with charges and codes. Provide maximum contribution to the maintenance of accounts receivable at the goal or objective establish by the corporation. Assist in development and maintenance of operational policy and procedures and budget. Maintain required Certifications/Licensures. Required Skills: Three years experience with utilization review, medical coding and/or patient financial services. Clinical experience in an acute care setting. Desired Skills: R.N. or L.P.N. designation Minimum Educational Requirements: BA/BS in a related field and/or a combination of relevant education and experience. Perot Systems is committed to Equal Employment Opportunity. It is the policy of Perot Systems Corporation to encourage and support equal employment opportunity for all Associates and applicants for employment without regard to sex, race, color, ancestry, religious creed, national origin, pregnancy, physical disability, mental disability, medical condition, age, marital status, political affiliation, sexual orientation, disabled veteran or Vietnam era veteran status.Click here to apply via the Perot Systems Career Opportunity PortalExpected Travel Time: None You are Applying to: Nurse Auditor (17332), Perot Systems, US-WA-Renton Minimize Step 1: * = Required Information First name * Required Last name * Required Email address * RequiredInvalid Email me a copy of my application Privacy Notice: We’ll save your name, resume, and the email address you've entered so that we can contact you about the status of your application if necessary, and for our internal reporting purposes. 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