Healthcare Billing Audit Nurse I

2 weeks ago

Fort Worth, Texas, United States CorVel Corporation Full time

The Healthcare Billing Audit Nurse is responsible for conducting thorough audits of hospital billing charges by examining medical records to ensure that services rendered align with the charges based on clinical documentation and established industry standards. The audits may encompass various categories, including inpatient, outpatient, NICU, and hospice services. This role is crucial in identifying discrepancies such as overcharges, undercharges, and unbundled items in accordance with payer contracts and industry norms. The candidate will need to manage independent scheduling, which requires flexibility and potential travel to various provider locations.

This position is remote.

KEY RESPONSIBILITIES:

Schedule and travel for onsite audits – acknowledge assigned work, maintain timely communication with the Audit Coordinator, and complete audits efficiently. Conduct onsite visits as necessary to perform audits. Analyze medical records to confirm the accuracy of services provided and charges – identify overcharges, undercharges, unbundled items, errors, duplicates, and routine services, equipment, and supplies. Document any discrepancies found using standard documentation protocols relevant to the role. Utilize audit and data information to make informed decisions yielding accurate results. Record all unsupported charges identified during audits 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 information confidentiality. Follow all provider and internal policies and guidelines. Represent CorVel Corporation 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 essential for positive interactions with both external and internal stakeholders. Capability to manage stressful situations and adapt as necessary. 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 OR, ICU, or ER as an RN 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 requirements, geographic location differentials, job-related skills, experience, qualifications, internal employee equity, and market conditions. Adjustments to these ranges may occur at any time.

For leveled roles (I, II, III, Senior, Lead, etc.), new hires may be placed at a different level based on assessments during the interview process, considering experience, qualifications, and overall fit for the role. The level may influence the salary range, and these details 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 CorVel Corporation

CorVel Corporation is dedicated to providing value, expertise, and a commitment to our partners. Through our clinical knowledge and cost containment solutions, we ensure accuracy and transparency in healthcare payments. We are a stable and growing organization with a supportive culture and numerous 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.

#LI-Remote

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