Nurse Auditor
3 weeks ago
Nurse Auditor
Location: 100% remote
Duration: 2 month contract with extensions
Pay: $35-40/hour
MUST BE ABLE TO WORK ON W2 WITHOUT SPOSNORSHIP**
A client in the greater Nashville, TN area is looking for a REMOTE Nurse Auditor to join their team. The Nurse Auditor must have well developed knowledge and skills in areas of utilization management, medical necessity, billing standards, national clinical guidelines, and audit of charges. The Nurse Auditor provides analysis of medical services, reports, clinical records, and billed charges, etc. to determine appropriateness of billed charges, determination of benefit coverage and compensability under the coverage guidelines. The Nurse Auditor will use their expertise and clinical judgement to resolve denial/reduction of billed charges by clinical appeal, clinical audit, or recommendation of next steps to Revenue Service to achieve resolution to the claim.
Desired Skillset:
- 3-5 years of hospital clinical experience in acute care, surgery, and/or orthopedics
- Associates or Bachelor’s Degree in Nursing.
- Knowledge and understanding of hospital billing/charging methodology including UB04, itemized statements, revenue codes, CPT/HCPCS codes, ICD10 diagnosis and procedure codes.
- Strong working knowledge of CMS, complex claims payors and other industry guidelines.
- Previous experience in Utilization Management, Clinical Audit, or medical review.
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