Hospital Charge Audit Nurse Auditor RN Details

Hospital Charge Audit Nurse Auditor RN

Change Healthcare - Maine

Employment Type : Full-Time

Hospital Charge Audit Nurse Auditor RN

Overview of Position
The Hospital Charge Audit Nurse Auditor RN will perform remote and onsite hospital charge audits of both inpatient and outpatient hospital claims as assigned. Audits are conducted as a medical record review of all billed charges to identify over, under and late charges; as well as ensure provider reimbursement is within client guidelines and policies. These are not DRG or medical necessity audits.

What will be my duties and responsibilities in this job?

• Perform remote and onsite hospital bill charge audits as assigned while meeting department quality expectations
• Manage case inventory to ensure timely scheduling of remote and onsite audits while maintaining weekly productivity goals
• Ability to assess case details and provide input into audit potential of facilities & cases
• Effectively interact and communicate with teammates & providers regarding all steps of the audit process. Some interaction with clients may occasionally be required as well.
• Utilize nursing knowledge in conjunction with interpretation of the medical record to identify discrepancies in billed charges
• Develop recommendations and possible solutions to resolve audit disputes that have resulted in incomplete audit closure
• Other duties as requested

What are the requirements needed for this position?

• Graduate of an accredited College or University
• Current R.N. license
• Two years of clinical experience in an acute care hospital
• Two years medical claim review or experience as a utilization nurse
• Experience in use of the electronic medical record (EMR)
• Excellent organizational skills with a strong focus on attention to detail
• Knowledge of acute hospital billing requirement including UB-04s, revenue codes, itemization of charges, CPT codes, HCPCS codes ICD 10 diagnosis and procedure codes
• Proficiency with Microsoft office including Outlook, Word and Excel computer skills

What other skills/experience would be helpful to have?

• BSN preferred
• Two years hospital charge audit experience
• Medical coding credentials
• Operating room, ICU experience
• Ability to follow up and resolve issues in a timely manner
• Excellent critical thinking/problem solving skills
• Excellent verbal and written communication skills to include professional communication to facilities
• Ability to work independently as well as recognize when administrative or clinical support is needed
• Ability to multitask in a fast-paced environment
• Ability to organize, plan, prioritize and complete assignments within the required time frame
• Ability to prepare clear, concise, and legible audit forms
• Ability to self-schedule for audits and travel

What are the working conditions and physical requirements of this job?

The working area (environment) depends on the facility being audited; very often the on-site workspace may be limited and challenging.

The ability to sit or stand for long-periods of time, on occasion for the full length of the audit. The ability to maneuver all required audit equipment, i.e. laptop, manuals, files and charts, etc. over varying distances.

How much should I expect to travel?

50% travel should be assumed with overnight stays. Depending on Access to a major airport is required. Employee may live in any state. Depending on volume of work and employee location, required travel may be by car, air or both.

Employees in roles that require travel will need to be able to qualify for a company credit card or be able to use their own personal credit card for travel expenses and submit for reimbursement.

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Join our team today where we are creating a better coordinated, increasingly collaborative, and more efficient healthcare system!

COVID Vaccination Requirements

We remain committed to doing our part to ensure the health, safety, and well-being of our team members and our communities. As such, we require all employees to disclose COVID-19 vaccination status prior to beginning employment and we may require periodic testing for certain roles. In addition, some roles require full COVID-19 vaccination as an essential job function. Change Healthcare adheres to COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance.

Equal Opportunity/Affirmative Action Statement

Change Healthcare is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status. To read more about employment discrimination protections under federal law, read EEO is the Law at https://www.eeoc.gov/employers/eeo-law-poster and the supplemental information at https://www.dol.gov/ofccp/regs/compliance/posters/pdf/OFCCP_EEO_Supplement_Final_JRF_QA_508c.pdf.

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Click here https://www.dol.gov/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf to view our pay transparency nondiscrimination policy.

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Change Healthcare maintains a drug free workplace and conducts pre-employment drug-testing, where applicable, in accordance with federal, state and local laws.