Nurse Auditor

Job Description

Schedule: FT, Mon - Fri, Days

At Children's, the region's only full-service pediatric healthcare center, our people make us the very best for kids. Come cultivate your passion, purpose and professional development in an environment of excellence and inclusion, where team members are supported and deeply valued. Opportunities for career growth abound as we grow our services and spaces, including the cutting-edge Hubbard Center for Children. Join our highly engaged, caring team-and join us in providing brighter, healthier tomorrows for the children we serve. Children's is committed to diversity and inclusion. We are an equal opportunity employer including veterans and people with disabilities.

A Brief Overview
Responsible for auditing and reconciling Hospital accounts to medical record at 3 days post discharge to ensure accuracy and in compliance with regulatory requirements, hospital and system policies and procedures. This position will complete audits to ensure that the clinical documentation contained within the patient chart supports items and services included on the patient bill and identifies and corrects errors or discrepancies to accurately support billing and payment. In addition, the Nurse Auditor will complete requests for account audits by third party agencies. The Nurse Auditor position ensures clinical documentation supports all patient billing, verifies all patient services are listed for payment, and provides education/training regarding proper billing requirements. The Nurse Auditor will work collaboratively within Revenue Cycle, Compliance and Clinical departments to ensure the capturing of appropriate charges.

Essential Functions

• Conducts concurrent reviews of all selected discharges by reconciling billed charges to clinical records, making appropriate corrections based on results and communicating with clinical team leaders.
• Ensures that all requests for account audits by third parties are scheduled and investigated in a timely and accurate manner.
• Reviews account audits with representatives of third-party agencies and negotiate equitable settlements. Involving Director of Managed Care when appropriate.
• Analyzes data obtained from concurrent reviews to identify charge systems or workflows that are functioning at less than optimum levels.
• Intervenes and takes appropriate action to foster real-time compliance with regulatory, national, and regional guidelines, as well as internal hospital and system policies and procedures. Interventions to promote compliance may include discussion, and/or collaboration with external departments.
• Assist other Revenue Cycle Teams with supporting clinical documentation in writing payer appeals.
• Other duties as assigned
• Regular attendance at work is an essential function of the job.
• Perform physical requirements as described in the Physical Requirements section
• Provides training and in services to hospital staff to ensure that all information utilized in patient accounts, medical records and billings is accurate and adequately documented

Education Qualifications

• Bachelor's Degree from an accredited college or university in nursing Required

Experience Qualifications

• Minimum 5 years experience of clinical nursing required, intensive care/med surg experience in a pediatric setting Required and
• Experience in Hospital Billing Audits Required and
• Knowledge of CPT/HCPCS codes, regulatory guidelines and Hospital Billing Preferred

Skills and Abilities

• Ability to transport potentially heavy stacks of medical charts between the hospital and the billing audit area.
• Effective interpersonal skills to provide assistance and education to other departments and to parents.
• Analytical skills to perform accurate and extensive audits on selected patient accounts.
• Proficient use of a calculator and multiple systems to retrieve data needed for audit.

Licenses and Certifications

• RN - Registered Nurse - State Licensure and/or Compact State Licensure valid in the state of Nebraska Required

Children's is the very best for kids and the very best for your career At Children's, we put YOU first so together, we can improve the life of every child

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