- Four years of nurse auditor, billing compliance or charge entry experience preferred.
- RN- Registered Nurse with 2 years of clinical experience.
- Thorough understanding of hospital billing, chart reviews and coding, UR and Case Management, payer contract and reimbursement rates, and other revenue cycle functions.
- Great oral and written communication skills.
- Conducts coding audits, quality assurance assessments of claims, reviews statistical samples and analyzes for risk.
- Reviews and audits documentation in the medical records and charges submitted including CPT and ICD-10 information to ensure compliance.
- Applies nursing expertise to ensure compliance with medical policy, medical necessity guidelines and accepted standards of care.
- Conducts audits to determine if claims adhere to specific provider and hospital contracts.
- Ensures that medical claims, medical records and other documentation essential to proper billing is compliant with federal regulation, company policies and industry standards.
- Analyzes billing trends to identify areas of non-compliance and prepares regular reports on audit findings.
- Writes audit reports, as applicable. Assesses and communicates the level of risk associated with the audit issues identified in the report.
- Conducts surveys of complex audit areas to define the scope and objectives of audits.
- Assists in the development of overall audit plans, including comprehensive audit programs that identify specific procedures and tests designed to achieve the audit objectives.
- Educates staff when deficiencies in documentation and code selection are identified
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Nurse Auditor - Irving, United States - PSN Affiliates
Description
Nurse Auditor (FT)
FACILITY: PSN Affiliates
LOCATION: Irving, Texas
TYPE: Full Time
Physicians Surgical Network Affiliates, are looking for full-time Nurse Auditors to join our team. PSN Affiliates, manages surgery centers throughout Texas and is looking for talented Auditors to partner with to give superior patient care.
Minimum Requirements
Compensation and Benefits:
*COMPETITIVE HOURLY RATE *VISION
*401K *MEDICAL
*PTO Accrued *DENTAL
Position Summary:
This position is responsible for reviewing, auditing and reporting on revenue integrity with a focus on charge issues and risks at the departmental and facility level; educating hospital staff on charge reports, charging procedures and changes regarding charges as well as revenue integrity opportunities including but not limited to: analyzing claim denials issues, auditing hospital accounts, serving an integral role on the Revenue Cycle Team, leading revenue charge capture work groups, developing summary reports for management and revenue producing departments, and ensuring billing compliance.
Other Responsibilities:
*****PSN AFFILIATES PROVIDES SERVICES THROUGHOUT THE TEXAS AREA TO INCLUDE BUT NOT LIMITED TO EL PASO, SAN ANTONIO, AUSTIN, PLANO, FORT WORTH, CARROLLTON, FRISCO, AND IRVING*****
