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Nurse Auditor - Medical Bill Review (Part-Time, Remote)

Posted 2024-09-06

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💎 Seniority level: Middle, 3-5 years

🔍 Industry: Medical cost containment

🗣️ Languages: English

⏳ Experience: 3-5 years

🪄 Skills: Negotiation

Requirements:
  • RN (or LPN) with active professional license or equivalent.
  • CPC and/or CPC-H certification strongly desired.
  • Specialized training in hospital coding, ortho, neuro, rehab, or ER procedures.
  • 3-5 years of clinical experience in acute care, surgery, and/or orthopedic.
  • Workers' Compensation medical bill review experience is a major plus.
  • Knowledge of CPT and ICD-10 codes and Medicare guidelines.
  • Customer service orientation with strong communication skills.
  • Experience in deposition or litigation cases is a plus.
Responsibilities:
  • Audit medical and billing records to ensure services are reasonable, appropriate, and necessary.
  • Identify charges unrelated to the occurrence and verify billing compliance.
  • Initiate contacts with clients and medical providers as needed.
  • Meet productivity and turn-around time requirements.
  • Adhere to quality standards and HIPAA rules.
  • Negotiate bills and conduct re-evaluation reviews.
  • Serve as a resource for co-workers and improve job skills.
  • Maintain confidentiality and follow reporting formats.
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