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Nurse Charge Auditor
Affordable Housing Trust for Columbus and Franklin CountyClinical Appeals Review Nurse responsible for clinical denial reviews and audits in healthcare consulting for UASI. Analyzing billing and charging policies in patient accounts with a focus on accuracy and compliance.
About the role
Key responsibilities & impact- Completes clinical review of pre- and post-claim denials
- DRG Denials
- Perform a variety of audit services including charge audit, compliance audit, medical necessity, denials and other requests as needed. Audits may be performed on a concurrent or retrospective basis
- Review and analyze the client inpatient and/or outpatient itemized billing statement and the patient medical record and related documentation to identify items that were not billed correctly.
- Document findings on appropriate form and submit findings to client management staff daily so new billing forms can be generated in hospitals billing systems.
- Adhere to the National Health Care Billing Audit Guidelines, UASI Code of Conduct and Compliance Program, and the client third party audit policy while performing all duties.
- Attend meetings with members of client-hospital finance, medical records, and ancillary departments.
- Educate Client-Hospital personnel on validation and documentation of charges if requested by client contract relationship.
- Navigate hospitals medical record system and understand where to locate the financial information in relation to the patient payor billing information
Requirements
What you’ll need- RN Certification
- CCDS or CDIS Certification preferred
- Experience with DRG Denials
- Epic experience preferred
- InterQual and Medical Necessity experience
- Ability to read and comprehend itemized billing statement, patient medical record and other laboratory reports
- Ability to analyze medical information and determine appropriate billing procedures
- Ability to effectively communicate with others
- Analytical thinking process
Benefits
Comp & perks- Medical, dental, vision and life insurance, short/long-term disability, 401(K) and referral bonuses
- Training opportunities and reimbursement for professional certifications
- UASI's unique approach to employee appreciation which include: birthday recognition, holiday gift selections, performance awards, and years of service awards
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
clinical reviewaudit servicescharge auditcompliance auditmedical necessitybilling proceduresanalyze medical informationitemized billing statementpatient medical recordDRG Denials
Soft Skills
effective communicationanalytical thinking
Certifications
RN CertificationCCDS CertificationCDIS Certification