Nurse Auditor for Hospital Billing

2 weeks ago

Fort Worth, Texas, United States CorVel Corporation Full time

The Nurse Auditor for Hospital Billing is responsible for conducting thorough audits of hospital billing charges by examining medical records to ensure that services rendered align with charges based on clinical documentation and industry standards. The audits may encompass various settings, including inpatient, outpatient, NICU, and hospice care. This role focuses on identifying discrepancies such as overcharges, undercharges, and unbundled services in accordance with payer contracts and established industry practices. The selected candidate will need to manage their own scheduling, which requires flexibility and travel to various provider locations.

This position is remote.

KEY RESPONSIBILITIES:

Manage onsite scheduling and travel – acknowledge assigned work, maintain timely communication with the Audit Coordinator, and efficiently schedule and complete audits. Travel to provider locations as necessary to perform audits. Review medical records to confirm that services were delivered and charges are accurate – identify overcharges, undercharges, unbundled items, errors, duplicates, and routine services, equipment, and supplies. Document any discrepancies found during the audit process using standard documentation protocols relevant to the role. Analyze audit data to make informed decisions with precise outcomes. Record all unsupported charges identified during the audit for each case. Report any issues encountered during the audit process to the manager or supervisor for resolution. Adhere to all HIPAA regulations and other laws regarding patient confidentiality. Follow all provider and internal policies and guidelines. Represent CorVel/CERIS in a professional and knowledgeable manner. Perform additional duties as assigned by the manager or supervisor.

REQUIRED KNOWLEDGE & SKILLS:

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

EDUCATION & EXPERIENCE:

An Associate Degree in Nursing or higher is required. Current licensure as a Registered Nurse in the state of employment must be maintained. Previous experience in medical bill auditing, whether external or internal, is highly preferred. A minimum of 5 years' experience in the OR, ICU, or ER as a Registered Nurse is highly preferred. Experience in hospice care is a plus.

COMPENSATION:

CorVel employs a market-based approach to compensation, and salary ranges may vary based on location. Pay rates are determined by factors such as federal, state, and local minimum wage laws, geographic location differentials, job-related skills, experience, qualifications, internal equity, and market conditions. These ranges may be adjusted at any time.

For leveled positions (I, II, III, Senior, Lead, etc.), new hires may be placed into a different level based on assessments conducted during the interview process, considering experience, qualifications, and overall fit for the role. The level may influence the salary range, and these adjustments will be clarified during the offer process.

Pay Range: $60,846 – $90,940

A comprehensive list of our benefits can be found on the CorVel website: CorVel Careers | Opportunities in Risk Management.

About CERIS

CERIS, a division of CorVel Corporation, a certified Great Place to Work Company, is dedicated to providing incremental value, expertise, and a sincere commitment to our valued partners. Through our clinical proficiency and cost containment solutions, we strive for accuracy and transparency in healthcare payments. We are a stable and growing organization with a supportive culture and numerous opportunities for career advancement. We uphold our core values of Accountability, Commitment, Excellence, Integrity, and Teamwork (ACE-IT).

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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