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Healthcare Billing Audit Nurse I
2 months ago
The Healthcare Billing Audit Nurse is responsible for conducting thorough audits of hospital billing charges by examining medical records to ensure that services rendered are accurately billed in accordance with medical documentation and industry standards. The audits may encompass various settings, including inpatient, outpatient, NICU, and hospice care. This role is crucial in identifying discrepancies such as overcharges, undercharges, and unbundled services as per payor agreements and established guidelines. The candidate will manage their own scheduling, necessitating flexibility and potential travel to various provider locations.
This position is remote.
KEY RESPONSIBILITIES:
Schedule and perform audits efficiently while maintaining communication with the Audit Coordinator Travel to locations as required to execute audits Analyze medical records to confirm that services were provided and charges are correct – Identify any overcharges, undercharges, unbundled items, errors, duplicates, and routine services, equipment, and supplies Document any discrepancies found using standardized guidelines relevant to the role Utilize audit and data information to make informed decisions 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 all HIPAA regulations and maintain confidentiality of patient information Follow all provider and internal policies and procedures Represent CorVel/CERIS professionally and knowledgeably Perform additional duties as assigned by managementREQUIRED 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, payor, and other industry guidelines is preferred Proficient computer skills for managing correspondence, data entry, and virtual meetings Reasonable proficiency in Microsoft Office applications, particularly Excel Exceptional attention to detail Advanced organizational, strategic, and critical thinking abilities Excellent communication skills for positive interactions with both internal and external stakeholders Ability to manage stressful situations and adapt as necessary Capacity to thrive in a fast-paced environment Ability to work independently and think criticallyEDUCATION & EXPERIENCE:
An Associate Degree in Nursing or higher is required Current licensure as a Registered Nurse in the state of employment is mandatory Previous experience in medical billing audits, either external or internal, is highly preferred A minimum of 5 years of experience in OR, ICU, or ER as an RN is strongly preferred Experience in hospice care is a plusCOMPENSATION:
CorVel utilizes a market-based approach for compensation, and salary ranges may vary based on geographic location, job-related skills, experience, qualifications, and market conditions. Adjustments to salary ranges may occur at any time.
For leveled positions (I, II, III, Senior, Lead, etc.), new hires may be placed in a different level based on assessment during the interview process, which considers experience, qualifications, and overall fit for the role. This level may influence the salary range, and any adjustments will be clarified during the offer process.
Pay Range: $60,846 – $90,940
A comprehensive list of benefits can be found on the CorVel website: CorVel Careers | Opportunities in Risk Management
About CERIS
CERIS, a division of CorVel Corporation, is committed to delivering value, expertise, and dedication to our partners. With a focus on clinical excellence and cost containment solutions, we prioritize accuracy and transparency in healthcare payments. We are a stable and growing organization with a supportive culture and ample opportunities for career advancement. Our core values include 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.
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