Position Overview: This role is crucial for ensuring accurate and equitable hospital billing practices. The primary responsibility involves conducting thorough audits of hospital bills by reviewing medical records to confirm that services rendered correspond with charges, following established medical documentation and industry standards. Identifying overcharges, undercharges, and discrepancies is essential for maintaining compliance with payor contracts. Flexibility and travel to various provider locations may be required.
Location: Remote
Key Responsibilities
- Onsite Scheduling and Travel: Manage your schedule efficiently and maintain communication with the Audit Coordinator to ensure timely completion of audits.
- Medical Record Review: Assess medical records to verify that services were delivered accurately, documenting any discrepancies such as overcharges, undercharges, unbundled items, and routine services.
- Discrepancy Documentation: Document discrepancies found during audits, following established guidelines.
- Decision Making: Leverage audit and data information to make informed decisions leading to accurate results.
- Charge Documentation: Record unsupported charges identified during each audit case.
- Problem Reporting: Communicate any process-related issues to your manager or supervisor for resolution.
- Regulatory Compliance: Follow HIPAA regulations, maintain confidentiality, and adhere to provider and internal policies.
- Professional Representation: Represent the organization professionally and knowledgeably in all interactions.
- Additional Duties: Perform other responsibilities as needed, as assigned by your manager or supervisor.
Knowledge & Skills
- Understanding of hospital billing practices, including UB-04 forms, itemized bills, and medical coding (CPT/HCPCS, ICD-10).
- Preferred knowledge of CMS, payor, and industry guidelines.
- Proficient computer skills for data management and virtual meetings, with familiarity in Microsoft Office applications, especially Excel.
- Detail-oriented with strong organizational skills.
- Advanced strategic and critical thinking skills.
- Excellent communication skills to foster positive relationships with stakeholders.
- Ability to manage stress and adapt to changing situations.
- Capable of working independently in a fast-paced environment.
Education & Experience
- An Associate Degree in Nursing or higher is required.
- Current licensure as a Registered Nurse in your state of employment must be maintained.
- Previous experience in medical bill audits (internal or external) is highly preferred.
- A minimum of 5 years of experience as a Registered Nurse in the Operating Room (OR), Intensive Care Unit (ICU), or Emergency Room (ER) is also preferred.
- Hospice experience is a plus.
Compensation: The salary range for this position is approximately \(60,846 - \)90,940, depending on location and qualifications. Pay rates are based on federal, state, and local minimum wage requirements, geographic location, job-related skills, experience, and market conditions. New hires may be placed at different levels based on interview assessments which consider experience, qualifications, and fit for the role, potentially affecting the salary range.
Benefits: A comprehensive benefits package is offered. Please visit our careers page for a complete list of available benefits and opportunities.
Employment Type: Full-Time