Full-Time
Nurse Auditor
Direct Staffing
No salary listed
Salt Lake City, UT, USA + 6 more
More locations: Seattle, WA, USA | Tacoma, WA, USA | Medford, OR, USA | Burlington, WA, USA | Moscow, ID, USA | Portland, OR, USA
Hybrid
Must work on-site for 6 months before telecommute option is considered.
Category
 Medical, Clinical & Veterinary (2) |
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Required Skills
Excel/Numbers/Sheets
Requirements
- Proven knowledge of medical and surgical procedures and other healthcare practices and trends.
- General computer skills including Microsoft Office (specifically Excel and Outlook) and internet search.
- Familiarity with health care documentation systems.
- Strong verbal, written and interpersonal communication and customer service skills.
- Ability to communicate audit outcomes and testing results with staff who are 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 their role and responsibilities.
- Proven ability in developing and following an audit program.
- Demonstrated competency in claim review and experience in using billing and claims forms (UB, CMS, and Health Care Financing Administration forms).
- An Associate or Bachelor’s Degree in Nursing or related field with 5 years of hospital quality management, coding or medical auditing experience or equivalent combination of education and experience.
- Registered nurse license with current unrestricted status for medical care management.
- Certified Coder certification preferred (American Academy of Professional Coders or American Health Information Management Association).
- RN license required in Washington, Oregon, Idaho, or Utah.
Responsibilities
- Plan, coordinate, conduct and report on post payment claims audits and perform related special projects as assigned.
- Conduct coding audits and quality assurance assessments of claims and review statistical samples and analyses for risk.
- Conduct surveys of complex audit areas to define the scope and objectives of audits.
- Assist in the development of overall audit plans, including comprehensive audit programs that identify specific procedures and tests designed to achieve the audit objectives.
- Identify problems or needed changes, recommend resolution, and participate in quality improvement efforts.
- Respond in writing or by phone to members, providers and regulatory organizations in a professional manner while protecting confidentiality of sensitive documents and issues.
- Provide consistent and accurate documentation.
- Plan, organize and prioritize assignments to comply with performance standards and corporate goals.
Desired Qualifications
- Certified Professional Coder preferred.
- Experience working with Skilled Nursing Facilities or a varied clinical setting with chart auditing experience strongly preferred.
- Experience with other health insurance plans is preferred.