Remote Nurse Auditor - Medical Review Bill

Job Overview

We are currently seeking a dedicated Nurse Auditor to join our esteemed team in a remote capacity. This position is pivotal in our commitment to medical cost containment, allowing you to apply your clinical acumen in the review of medical bills for accuracy, coding integrity, and regulatory compliance. Your contributions will directly assist our clients in identifying financial discrepancies and ensuring adherence to industry standards.

Key Responsibilities

• Conduct thorough audits of medical and billing records to confirm that services provided are both reasonable and accurately billed.
• Assess charges that may not be relevant to the incident under review.
• Ensure that billed services correspond with those that have been authorized and ordered.
• Collaborate effectively with clients and healthcare providers as necessary.
• Consistently achieve productivity targets and adhere to turnaround time requirements.
• Comply with state billing regulations, quality standards, HIPAA guidelines, and maintain confidentiality at all times.
• Perform re-evaluations and negotiate billing discrepancies when required.
• Serve as a knowledgeable resource for colleagues, offering support and advice.
• Display cultural sensitivity and professionalism in all engagements.
• Engage in ongoing education regarding billing practices, medical coding, and industry developments through training and research.
• Ensure that all documentation and reports meet organizational standards.
  
  

Required Skills

• Active RN or LPN license (or equivalent) in relevant states.
• Highly preferred certifications include CPC and/or CPC-H.
• Specialized training in hospital coding, including areas such as orthopedics, neurology, rehabilitation, or emergency procedures.
• Strong understanding of CPT, ICD-10 codes, and Medicare regulations.
• Proficiency in interpreting and applying state-specific fee schedules.
• Exceptional communication skills with a focus on customer service.
• Experience with deposition or litigation processes is an advantage.
  
  

Qualifications

• A minimum of 3-5 years of clinical experience in acute care, surgical settings, and/or orthopedics.
• Experience with Workers' Compensation medical bill review is a significant asset.
  
  

Career Growth Opportunities

Joining our team provides you with the chance to develop professionally in a supportive environment that champions innovation and long-term growth. You’ll have opportunities to enhance your skills while being part of a network committed to excellence in healthcare.

Company Culture And Values

We pride ourselves on fostering a relaxed, supportive, and positive work atmosphere where collaboration and professional development are encouraged. As a part of our team, you will be surrounded by like-minded professionals who are committed to making a significant impact in the healthcare sector.

Compensation And Benefits

• This position offers remote work with part-time hours (20-24 hours per week).
• Competitive compensation commensurate with experience.
• Access to our Elevate program, designed to acknowledge and reward your contributions to our success.
  
  

Employment Type: Full-Time