Interviewing for Nurse Auditors (RN/LPN) with a passion for people and processes.  In the Nurse Auditor, RN/LPN role, you will partner with patients to analyze their medical records and determine that all documentation correctly identifies the patient's quality of care, medical necessities, ability to pay insurance, and utilization of their stay.

Salary up to $70k/year.  DOE based on location and number of years of experience + license/certifications. Performance is measured by quality performance, financial outcomes, budgets, and overall team/department goal achievement. 


Nurse Auditors (RN/LPN) Responsibilities

• Ensure all patient paperwork adheres to all charging practices and legal standards.
• Review billing process, understand and define the purpose for denials, and navigate the appeals process. 
• Audit accounts to identify and resolve discrepancies and communicate all updates with the patients and internal departments. 
• Manage activity on paid care accounts, patient billing accounts, and other government accounts as assigned.
• Reviewing third-party charges, grievances, and other billing issues to protect the interest of the organization.
• Serve as consultant and liaison between patient accounts and hospital departments.
• Perform audits of billings and reimbursements to ensure adherence to technical guidelines.
• Work with cross-functional RCM departments and report updates to supervisors including human resources and accounting.

Ideal Candidate will have...

• Bachelor Degree required (MBA preferred or equivalent experience)
• Clear and active RN/LPN license
• 5+ years experience working directly in a hospital, urgent-care setting, or insurance company
• Experience using billing and claims forms (UB, CMS and HCFA)
• Knowledge of medical coding systems (ICD-9/10, HCPCS, DRG and CPT-4)
• Strong MS Office experience
• Effective written and verbal communication
• Excellent negotiation skills

Position & Benefits
This position offers a comprehensive benefits package to include medical, dental, vision, and more.