Job Description
Have you ever glanced at a medical bill and noticed something wasn't quite right? Do you have the expertise and passion to make it right? If so, we want you on our team! We're seeking a dedicated Nurse Auditor who is eager to contribute to medical cost containment while ensuring clients receive exceptional service.
What You'll Do:
As a Nurse Auditor, you'll play a vital role in maximizing client savings by reviewing medical bills through a clinical lens. Your expertise will help ensure billing, coding, and treatment are appropriate, compliant with fee schedules, and free from errors. You'll be an essential part of our mission, providing clients with valuable insights based on your evaluations of medical records and billing statements.
Your responsibilities will include:
Auditing medical and billing records to assess the reasonableness, appropriateness, and necessity of services provided.
Identifying and evaluating any charges unrelated to the occurrence.
Verifying that charges align with the services ordered and authorized.
Initiating necessary communications with clients and medical providers.
Meeting productivity and turnaround time requirements consistently.
Adhering to quality standards, state billing guidelines, and HIPAA regulations to maintain confidentiality.
Negotiating bills and conducting re-evaluations as needed.
Serving as a resource for co-workers and demonstrating cultural sensitivity in diverse situations.
Continuously improving your skills and knowledge of our products and services through ongoing training and research.
Following established report formats and documentation guidelines.
Performing additional administrative tasks as requested.
This part-time position offers 20-24 hours of work each week, allowing you to balance your professional and personal life effectively.
What We're Looking For:
An active RN (or LPN) license or equivalent in our operational states.
CPC and/or CPC-H certification(s) are strongly preferred.
Specialized training in hospital coding, orthopedics, neurology, rehabilitation, or emergency procedures.
3-5 years of clinical experience in acute care, surgery, and/or orthopedics.
Experience with Workers' Compensation medical bill review is a significant advantage.
A solid understanding of CPT and ICD-10 codes, as well as Medicare guidelines.
The ability to apply knowledge to state fee schedules.
Strong communication skills and a customer service-oriented mindset.
Experience in depositions or litigation cases is a plus.
What We Offer:
A fully remote position.
Employment with a company dedicated to core values, staff development, and the integration of emerging technology. We believe in promoting from within!
The chance to make a real difference by helping reduce healthcare costs and increasing value for individuals and their employers.
A relaxed yet dynamic work environment.
Participation in our Elevate program, which recognizes and rewards employees for their hard work and dedication.
If you're ready to make a positive impact in the world of medical cost containment, we'd love to hear from you!
Employment Type: Full-Time
Salary: $ 34.00 Per Hour
Job Tags
Hourly pay, Full time, Part time,