Hospital Bill Audit Nurse Role Overview
In this role, you will be essential in ensuring the accuracy and fairness of hospital billing practices. Your primary duty will involve conducting detailed audits of hospital bills by reviewing medical records to confirm that the services rendered correspond with the charges and adhere to industry standards.
Key Responsibilities
- Scheduling and Communication: Efficiently manage your audit schedule while maintaining timely communication with the Audit Coordinator to complete audits within designated timelines.
- Onsite Audits: Travel to provider locations as required to conduct audits.
- Record Review: Scrutinize medical records to ensure the accuracy of charges, identifying overcharges, undercharges, unbundled items, errors, duplicates, and reviewing routine services, equipment, and supplies.
- Documentation: Record discrepancies following established guidelines to ensure all unsupported charges are noted for each case.
- Problem Reporting: Inform your manager or supervisor of any issues that arise during the audit process for quick resolution.
- Compliance: Follow HIPAA and other relevant regulations to protect patient confidentiality, alongside adhering to internal policies and guidelines.
- Professional Representation: Uphold a knowledgeable and professional demeanor while representing the organization.
- Additional Duties: Undertake other responsibilities as assigned by management.
Knowledge & Skills Required
- Strong knowledge of hospital billing and charging processes, including UB-04 forms, itemized bills, revenue codes, CPT/HCPCS codes, and ICD-10 diagnosis and procedure codes.
- Familiarity with CMS, payor, and industry guidelines is a plus.
- Proficient in computer skills for managing communication, information entry, and retrieval, and capable of participating in virtual meetings.
- Reasonable proficiency in Microsoft Office applications, particularly Excel.
- Exceptional attention to detail, strong organizational, strategic, and critical thinking abilities.
- Excellent communication skills for positive interactions with internal and external stakeholders.
- Ability to manage stressful situations and adapt in a fast-paced environment.
- Capability to work independently and apply critical thinking.
Education & Experience
- An Associate Degree in Nursing or higher is required.
- A current Registered Nurse license in the state of employment is mandatory.
- Prior experience in medical bill auditing is highly preferred.
- A minimum of 5 years of experience as an RN in settings such as OR, ICU, or ER is highly preferred; experience in hospice care is an advantage.
Compensation
The salary range for this position is between \(60,846 and \)90,940. Compensation is determined through a market-based approach, considering variables such as location, skills, experience, and internal equity. New hires may be placed at different levels based on their interview assessment.
Benefits
A comprehensive benefits package is available for full-time employees, including medical, dental, and vision insurance, long-term disability, health savings account options, life insurance, accident and critical illness insurance, legal insurance, parking and transit FSA accounts, 401K, and ROTH 401K options, alongside paid time off.
Employment Type: Full-Time