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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