Nurse Auditor - Medical Bill Review
Job Description:
- Audit medical and billing records to determine if services provided are reasonable, appropriate and necessary.
- Clinically identify and evaluate any charges not related to the occurrence.
- Verify that charges are in accordance with the services ordered and authorized.
- Initiate appropriate contacts with clients and medical providers as appropriate and necessary.
- Negotiate bills and conduct re-evaluation reviews as required
- All while maintaining a human touch, demonstrating sensitivity to culturally-diverse people and situations.
Requirements:
- RN (or LPN) with active professional license or equivalent within states of operation
- CPC and/or CPC-H certification(s) strongly desired
- Specialized training in hospital coding, ortho, neuro, rehab, or ER procedures
- 3-5 years of clinical experience in acute care, surgery and/or orthopedic
- Workers’ Compensation medical bill review experience a major plus
- Understanding of CPT and ICD-10 codes and Medicare guidelines
- Ability to apply knowledge to state fee schedules
- A customer service orientation, including strong communication skills
- Experience in any deposition or litigation cases a plus
Benefits:
- Competitive benefits package, including health insurance, 401(k) with company match, paid time off, paid holidays, and more.
- Flexible hybrid schedule with in-office days reserved for training and collaborative meetings
- Employment within a firm committed to core values, staff development, emerging technology, private ownership, and controlled growth/reinvestment in the future - we frequently promote from within!
- Opportunity to make a difference in reducing health care costs and increasing the value of health care to individuals and their employers.
- A relaxed, yet upbeat work environment
- And for those in the office: casual dress code with unlimited coffee!