Nurse Auditor

4 weeks ago

Richmond, Virginia, United States Universal Health Services Full time
Job Title: Nurse Auditor

We are seeking a skilled Nurse Auditor to join our team at Universal Health Services. As a Nurse Auditor, you will be responsible for resolving billing edits, coordinating and completing billing audits, educating business office and facility staff on charging and billing issues, and reviewing denial trends and high charge stays for billing accuracy.

Key Responsibilities:
  • Perform clinical reviews in response to claim denials by third-party payers.
  • Analyze medical records to confirm medical necessity as it pertains to inpatient level of care, readmissions, patient length of stay, non-covered services, experimental and investigational issues, ER Downgrades, DRG validation, and other claim denials.
  • Draft detailed clinical appeal letters to submit to third-party payers to obtain reimbursement for denied claims.
  • Make decisions to downgrade inpatient claims to observation status and perform calculation of observation hours.
  • Call third-party payers and physician offices as needed to obtain additional clinical details, retro-authorization requests, and clarity on denials.
  • Identify denial trends and provide feedback to management and to UHS acute care facilities.
Requirements:
  • RN or LPN licensure in good standing is required. BSN degree preferred.
  • Three to five years of experience is preferred.
  • CPC, CCS, or other coding credentials preferred, but not required.
  • Experience working in Patient Financial Services and an understanding of the Revenue Cycle from beginning to end is preferred.
  • Experience working in case management or audit with technical denials is preferred.
  • Strong Microsoft Office skills (Excel, Word, Outlook).
  • Customer-focused both internally and externally, strong attention to detail, the ability to multi-task.
  • Excellent written and oral communication skills are required.

We offer a competitive compensation package, excellent medical, dental, and vision plans, 401(k) with company match, and career development opportunities within UHS and its 300+ subsidiaries.

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