RN/LPN, Nurse Auditor

Responsibilities

• Performs charge audits and potential client assessments as assigned by management.
• Timely resolution of all incorrect and/or missing charges to prevent revenue loss and ensure compliance requirements are met.
• Identifies opportunities for additional documentation needs to support charges captured.
• Conducts regular audits to look for opportunities of missing and/or incorrect charges and reports to management.
• Fulfills audits requests by reviewing clinical documentation, identifying trends for missing and/or incorrect charges, and reporting on findings.
• Applies clinical knowledge to educate stakeholders on standards for documentation and charge capture practices and look for opportunities of improvement based on audit outcomes.
• Responsible for reviewing Injection & Infusion work queues in Epic. Resolve prebill and post bill missing and error charges identified by Opera Solutions software to prevent revenue loss and ensure accurate and timely billing of services provided.
• Support the organization in meeting its financial goals.
• Travel to clients’ sites as needed to conduct assessments and provide education and training related to findings.
• Respond to clients’ questions and audit requests in a timely manner.
• Meet and or exceed the department productivity and quality standards.
• Review CMS, OIG, and other pertinent government websites to keep abreast of all charge capture guidelines & how they may impact revenue.
• Maintain thorough understanding of government rules and regulations, generally accepted auditing standards and common audit procedures and techniques.

Requirements

• Current RN or LPN Licensure.
• Candidate must have and keep current at least one of the following professional certifications or other approved job relevant certification: CCDI (Certified Clinical Documentation Improvement), CCS (Certified Coding Specialist), RHIA (Registered Health Information Administrator), RHIT (Registered Health Information Technician), COC (Certified Outpatient Coder), PMP (Project Management Professional), CPMA (Certified Professional Medical Auditor).

Qualifications

• Working knowledge of CPT/HCPCS/Revenue codes, charge capture and billing best practices, and government and non-government reimbursement guidelines.
• Strong organization skills.
• Highly motivated and self-starter with ability to complete assignments within time constraints and deadlines.
• Ability to thrive in a dynamic & fast-paced work environment.
• Experience in physician and hospital operations, compliance and provider relations.

Skills

• Strong organizational skills.
• Ability to thrive in a dynamic & fast-paced work environment.
• Experience in physician and hospital operations, compliance and provider relations.

Benefits

Award-winning Company: Five-time winner of “Best in KLAS” 2020-2022, 2024-2025 Black Book Research's Top Revenue Cycle Management Outsourcing Solution 2021-2024 22 Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in Revenue Cycle 2019-2024 Leader in Everest Group's RCM Operations PEAK Matrix Assessment 2024 Clarivate Healthcare Business Insights (HBI) Revenue Cycle Awards for strong performance 2020, 2022-2023 Energage Top Workplaces USA 2022-2024 Fortune Media Best Workplaces in Healthcare 2024 Monster Top Workplace for Remote Work 2024 Great Place to Work certified 2023-2024

Join An Award-winning Company: We offer a comprehensive benefits package designed to support the physical, emotional, and financial health of you and your family, including healthcare, time off, retirement, and well-being programs.