Nurse Charge Auditor

Role Overview

• 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

• 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

• 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