Not Authorized
You are currently not authorized to access this section.
Please contact your Administrator to change your authorization settings.
Please contact your Administrator to change your authorization settings.
Nurse Review Auditor
Franklin, TN
Job Description
Position Summary:
The Nurse Review Auditor provides analysis of medical services, reports, records and billed charges, etc. to determine appropriateness of these charges, delivery of care and treatment plans. The Nurse Review Auditor will use his/her expertise and clinical judgement to negotiate with payers.
Key Responsibilities:- Applies clinical expertise and judgment to analyze, research and interpret medical services, bills, etc. and determines appropriateness of charges, delivery of care and treatment plans.
- Identify the necessity of the review process and communicate specific issues of concern to the Revenue Services team, client or member of management.
- Document work and final conclusions in designated company software.
- Documents persuasive clinical documentation to maximize provider reimbursement.
- Negotiates directly with payer/bill review contacts to ensure maximum reimbursement on medical bills.
- Provides assistance to Corporate Trainer on training staff on medical terminology, coding and anatomy.
- Maintains knowledge regarding legislative and/or healthcare market changes.
- Other duties as required.
- Associates or Bachelor's Degree in Nursing.
- Active Registered Nurse license in the state of employment.
- 5 years' of clinical experience on the hospital/facility side (e.g. O.R., I.C.U., C.C.U., E.R. or Orthopedics)
- Equivalent combination of education and experience will be considered.
- To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.
- Must have strong computer proficiency and understand how to use basic office applications, including MS Office (Word, Excel, and Outlook).
- Regular and predictable attendance.
- Proven knowledge of medical and surgical procedures and other healthcare practices and trends
- Current certification from AAPC as Certified Coder and Medical Coding expertise a plus.
- General computer skills (including use of Microsoft Office, specifically Excel and Outlook, internet search).
- Familiarity with health care documentation systems.
- Demonstrated competency in claim review and experience in using billing and claims forms (UB, CMS, and HCFA).
- Strong verbal, written and interpersonal communication and customer service skills.
- Ability to communicate audit outcomes and testing results with other staff within the company who are both medically and non-medically oriented.
- Ability to interpret policies and procedures and communicate complex topics to others.
- Strong organizational and time management skills with the ability to manage workload independently.
- Ability to think critically and make decisions within individual role and responsibility.
- Proven ability in developing and following an audit program.
EnableComp is an Equal Opportunity Employer M/F/D/V. All applicants will be considered for this position based upon experience and knowledge, without regard to race, color, religion, national origin, sexual orientation, ancestry, marital, disabled or veteran status. We are committed to creating and maintaining a workforce environment that is free from any form of discrimination or harassment.
Job Summary
Company
Start Date
As soon as possible
Employment Term and Type
Regular, Full Time
Required Education
Bachelor's Degree
Required Experience
5+ years
Email this Job to Yourself or a Friend