Nurse Auditor for Hospital Billing

2 weeks ago

Fort Worth, Texas, United States CorVel Full time


The Clinical Billing Audit Nurse is responsible for performing comprehensive audits of hospital billing by examining medical records to ensure that services rendered align with charges applied, adhering to medical documentation standards and industry regulations.

The audits may encompass various types, including inpatient, outpatient, NICU, and hospice services. This role aims to identify discrepancies such as overcharges, undercharges, and unbundled services in accordance with payer contracts and established industry practices. The selected candidate will need to manage independent scheduling, which requires flexibility and potential travel to various provider locations.

This position offers the flexibility of remote work.

KEY RESPONSIBILITIES:

  • Schedule and conduct audits efficiently, maintaining prompt communication with the Audit Coordinator.
  • Travel to sites as necessary to execute audits.
  • Analyze medical records to confirm the accuracy of services provided and corresponding charges, identifying any discrepancies such as overcharges, undercharges, unbundled items, errors, duplicates, and routine services.
  • Document any discrepancies found during audits in accordance with standard documentation practices.
  • Utilize audit data to make informed decisions and ensure accurate outcomes.
  • Record all unsupported charges identified during the audit process for each case.
  • Report any issues encountered during the audit process to the manager or supervisor for resolution.
  • Adhere to HIPAA regulations and maintain confidentiality of patient information.
  • Follow all provider and internal policies and guidelines.
  • Represent CorVel/CERIS in a professional and knowledgeable manner.
  • Perform additional duties as assigned by management.

REQUIRED KNOWLEDGE & SKILLS:

  • In-depth knowledge of hospital billing processes, including UB-04 forms, itemized bills, revenue codes, CPT/HCPCS codes, and ICD10 diagnosis and procedure codes.
  • Strong familiarity with CMS, payer, and other relevant industry guidelines is preferred.
  • Proficient computer skills for managing correspondence, data entry, and retrieval, along with the ability to engage in virtual meetings.
  • Competency in Microsoft Office applications, particularly Excel.
  • Exceptional attention to detail.
  • Advanced organizational, strategic, and critical thinking abilities.
  • Excellent communication skills to interact effectively with both internal and external stakeholders.
  • Capability to manage stressful situations and adapt as necessary.
  • Ability to thrive in a fast-paced environment.
  • Capacity to work independently.

EDUCATION & EXPERIENCE:

  • An Associate Degree in Nursing or higher is required.
  • Current licensure as a Registered Nurse in the state of employment is mandatory.
  • Prior experience in medical billing audits, either externally or internally, is highly preferred.
  • A minimum of 5 years of experience in the OR, ICU, or ER as a Registered Nurse is strongly preferred.
  • Experience in hospice care is an advantage.

COMPENSATION:
CorVel employs a market-based approach to compensation, and salary ranges may vary based on geographic location.

Compensation rates consider various factors including federal, state, and local minimum wage laws, geographic differentials, job-related skills, experience, qualifications, internal equity, and market conditions. Adjustments to these ranges may occur at any time.

Pay Range:
$60,846 - $90,940

For a comprehensive overview of our benefits, please visit the CorVel website: CorVel Careers | Opportunities in Risk Management.

About CERIS


CERIS, a division of CorVel Corporation, is recognized as a certified Great Place to Work Company, dedicated to delivering exceptional value and service to our partners.

Through our clinical expertise and cost containment solutions, we prioritize accuracy and transparency in healthcare payments. We are a stable and expanding organization with a supportive culture and numerous opportunities for career advancement. Our core values of Accountability, Commitment, Excellence, Integrity, and Teamwork (ACE-IT) guide our operations.


A comprehensive benefits package is available for full-time regular employees, including Medical (HDHP) with Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.

CorVel is an Equal Opportunity Employer, maintains a drug-free workplace, and complies with ADA regulations as applicable.

#LI-Remote

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