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Nurse Auditor

Loma Linda, California

Job Description

Full-Time 80 hrs pp AM Associates Degree CA RN license Job Summary: The Nurse Auditor performs detailed, concise, concurrent, and retrospective chart audit review for third party (Health Plan/Medical Group), LLUMC Legal Department, PBO Director, and Managers. Responsible for auditing patient billing for accuracy and appropriateness. Coordinates with patient care, physicians, health plans, and Revenue Cycle departments to enhance and defend the accuracy of the charge and coding processes. Prepares pre-billing charge capture for identified high risk and high dollar cases; establishes methods for documenting, tracking, and communicating findings to medical and administrative personnel. Participates in departmental quality improvement projects and collaborates with other departments on education of staff regarding opportunities for improvement as identified via audits. Utilizes analytical and interpersonal skills to maximize excellence in customer service and professionalism. Contributes to a work environment of caring and cooperation among a culturally diverse internal and external workforce and patient population. Performs other duties as needed. Job Specifications: Associate's degree in nursing required. Bachelor's degree in nursing preferred. Minimum of three years experience in case management or discharge planning, utilization review or internal auditing required. Minimum of five years of RN experience in an acute care setting required. Minimum of three years of charge defense auditing experience required. Minimum of five years experience with charge and billings processes and payer or CMS billing requirements preferred. Active California Registered Nurse License required. Current certification as a Certified Healthcare Chart Auditor preferred. Able to read, write legibly, speak in English with professional quality; use computer, printer, and software programs necessary to the position, e.g., ACCESS, EXCEL, WORD, OUTLOOK, MIDAS. Able to relate and communicate positively, effectively, and professionally with others; be assertive and consistent in following and/or enforcing policies; work calmly and respond courteously when under pressure; lead, supervise, teach, and collaborate; accept direction. Able to communicate effectively in English in person, in writing, and on the telephone; think critically; perform basic math functions required for auditing and basic statistical reports; manage multiple assignments effectively; compose written material; organize and prioritize workload; work well under pressure; problem solve; recall information with accuracy; pay close attention to detail; work independently with minimal supervision. Must have experience and strong working knowledge of medical terminology, charge description master, medical records charting, universal billing and line item review, in-depth understanding of acute hospital charge and posting practices ? charge bundling, duplication and under charging detection, medical coding, insurance billing and industry regulations, the ability to interpret health plan contract terms and conditions, and comprehensive understanding of healthcare revenue cycle and business office financials. *HJ*HJJD *MH*JD *SH*JD

Additional Requirements / Information

Job Capacity: Employee (full-time)
Minimum Education Level: See Job Description
Visa Sponsorship: No
Related Industries: Other