Nurse Auditor, RN/LPN
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.