Remote Nurse Auditor - Medical Billing Review | WFH at Get It Recruit - Healthcare

Job Overview

We are actively seeking a dedicated Nurse Auditor to join our esteemed team in a remote capacity. This role is crucial in driving medical cost containment efforts as you apply your clinical acumen to meticulously review medical bills for accuracy, compliance, and proper coding. Your contribution will not only help clients save significantly by identifying discrepancies but also enhance the overall efficiency of healthcare billing practices.

Key Responsibilities

• Conduct thorough audits of medical and billing records to ascertain the reasonableness and necessity of services billed.
• Evaluate charges that are unrelated to the incident in question.
• Ensure services billed correspond with those that were ordered and authorized.
• Collaborate effectively with clients and medical providers as required.
• Meet productivity goals and turnaround time expectations consistently.
• Adhere to state billing guidelines, HIPAA regulations, and maintain confidentiality throughout the process.
• Perform re-evaluation reviews and negotiate bills as needed.
• Act as a knowledgeable resource for colleagues by providing support and guidance.
• Show respect and sensitivity to diverse cultures and situations in all interactions.
• Stay updated on billing practices, medical codes, and industry standards through continuous training and research.
  
  

Required Skills

• Active RN or LPN license (or equivalent) in relevant states.
• CPC and/or CPC-H certification(s) are highly desirable.
• Specialized training in hospital coding, orthopedics, neuro, rehabilitation, or ER procedures.
• Solid understanding of CPT and ICD-10 codes, along with Medicare guidelines.
• Proficiency in interpreting and applying state fee schedules.
• Excellent communication skills with a strong emphasis on customer service.
• Experience in deposition or litigation cases is an added advantage.
  
  

Qualifications

• 3-5 years of clinical experience in acute care, surgery, and/or orthopedics.
• Familiarity with Workers' Compensation medical bill review is a significant plus.
  
  

Career Growth Opportunities

Joining our team offers you a unique chance to grow professionally in a supportive environment that values continuous learning and development. You will have access to our Elevate program, which is designed to recognize and reward your hard work while providing opportunities for skill enhancement.

Company Culture And Values

We pride ourselves on cultivating a relaxed, supportive, and positive work environment that emphasizes collaboration and respect for diverse perspectives.

Networking And Professional Opportunities

As part of our team, you will have the opportunity to engage with fellow professionals in the industry, enhancing your network and fostering meaningful connections that can benefit your career.

Employment Type: Full-Time