**Join Our Team as a Hospital Bill Audit Nurse**
We are looking for a detail-oriented professional to conduct thorough hospital bill charge audits. This role involves reviewing medical records to ensure that the services provided align with appropriate charges, adhering to medical documentation and industry guidelines. You will engage in various types of audits, including inpatient, outpatient, NICU, and hospice services. Your insights will be critical in identifying overcharges, undercharges, and unbundled items in accordance with payor contracts and industry standards. Flexibility and travel to provider locations for on-site audits are essential.
**Key Responsibilities**
- **Scheduling and Travel**: Coordinate and complete audits efficiently while maintaining communication with the Audit Coordinator. Engage in travel as necessary to conduct on-site audits.
- **Medical Record Review**: Analyze medical records to verify service provision and accuracy of charges while identifying discrepancies, including overcharges, undercharges, unbundled items, errors, and duplicates.
- **Discrepancy Documentation**: Record any discrepancies found during audits following standard documentation guidelines.
- **Data Analysis**: Utilize audit and data information to inform decisions and ensure accurate results.
- **Charge Documentation**: Log all unsupported charges discovered during the audit for each case.
- **Problem Resolution**: Communicate any issues arising in the audit process to management for timely resolution.
- **Compliance**: Uphold HIPAA regulations and internal policies regarding patient confidentiality.
- **Professional Representation**: Act as a knowledgeable and professional representative of the organization.
- **Additional Duties**: Undertake other responsibilities as assigned by management.
**Knowledge and Skills**
- In-depth understanding of hospital billing processes, including UB-04's, itemized bills, revenue codes, CPT/HCPCS codes, and ICD-10 diagnosis and procedure codes.
- Familiarity with CMS, payor, and industry guidelines is preferred.
- Competent in computer skills for managing correspondence, data entry, and virtual meetings, with proficiency in Microsoft Office, particularly Excel.
- Exceptional attention to detail, advanced organizational, strategic thinking, and critical thinking skills.
- Strong communication skills for effective interaction with both internal and external stakeholders.
- Capability to thrive in stressful situations and adapt in a dynamic environment while working independently.
**Education and Experience**
- An Associate Degree in Nursing or higher is required.
- Current licensure as a Registered Nurse in the relevant state is essential.
- Preferably, previous experience in medical bill auditing—internal or external.
- A minimum of five years' experience in the OR, ICU, or ER as an RN is strongly preferred; hospice experience is an added advantage.
**Compensation and Benefits**
- **Pay Range**: Salary varies by location and factors such as skills, experience, and market conditions, with a range of $60,846 - $90,940. Adjustments to compensation levels (I, II, III, Senior, Lead, etc.) may occur based on qualifications during the interview process.
- **Benefits**: A comprehensive benefits package is offered, including medical, dental, and vision insurance, long-term disability, health savings and flexible spending accounts, life insurance, accident and critical illness insurance, legal insurance, parking and transit FSA accounts, a 401K plan, ROTH 401K plan, and paid time off.
We welcome interested candidates to apply and look forward to potentially having you on our team!
Employment Type: Full-Time