Charge Audit Nurse
CHARGE AUDIT NURSE – MANAGED RESOURCES
Part-Time |Remote| Permanent
The Nurse Auditor will conduct audits on medical claim data and/or medical records to support charges. With the use of medical and nursing knowledge of patient care, procedures, medications and supplies, the Nurse Auditor will compare charges with documentation provided in the medical record to determine whether the documentation correctly identifies the patient' s quality of care, medical necessities, ability to pay insurance, and utilization of their stay. Nurse Auditors will promote optimization of revenue recovery as well as compliance in the billing process through utilization of the charge master, charge policies, and patient care policies of the Health System. Assist the MRI audit team to fulfill contractual obligations with one or more facilities and performs other duties as assigned.
Managed Resources is a leading consulting group assisting healthcare organizations nationwide in optimizing its revenue cycle management through review, recovery and educational programs.
Please read the below description and apply if you meet the requirements and would like to hear more about this opportunity with Managed Resources.
- Performs charge audits (concurrent or retrospective), defense audits, quality/compliance audits, pre/post EMR implementation audits and other medical record audits depending upon the clients’ requests and contract.
- Conducts all audits in a professional, ethical manner in accordance with the National Hospital Billing Audit Guidelines based on findings in the clinical documentation protecting the client’ s financial interests.
- Utilizes resources including communication with billing and coding staff, CMS regulations, CPT codes, medical record documents, journal articles and health system policies to determine appropriateness of charges.
- Researches, investigates and takes training to keep up to date on CMS regulations, HCPCs codes, ICD 9/10 diagnosis and procedure codes.
- Conducts pre- audit review of medical records in preparation for insurance reviews including details of care provided and reconciles findings with the information on the itemized bill.
- Prepares correspondence to insurance auditor including evidence of findings that support charges.
- Provides payer with information presented in the medical record, institutional policy and procedure, and /or research from medical literature to support the care that was provided and charged.
- Current and active Registered Nurse (RN) License required.
- Certification of Medical Audit Specialist (CMAS) preferred.
- Minimum of 3 to 5 years of clinical experience in an Acute Care Hospital
- Graduate of an accredited College or University
- Knowledge of the Revenue Cycle and hospital billing requirements including UB-04, revenue codes, itemization of charges, CPT codes, HCPCs codes, and ICD 9/10 diagnosis and procedure codes.
- Experience in working with Electronic Medical Records, i.e. Cerner, EPIC, Medi-Tech.
- Must possess strong math skills and ability to work with numbers.
- Proficient with Microsoft office and Excel computer program.
- Excellent organizational skills with a strong focus on detail.
- Excellent verbal and written communication skills.
- Ability to work independently and multi task in a fast paced, changing health care environment.
- Ability to organize, plan, prioritize, and complete assignments within the required time frame.
- Responsible for preparing clear, concise, and legible audit reports.
Job Ref #BH
Managed Resources is an Equal Opportunity Employer (EOE) M/F/D/V/SO
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