Registered Nurse - Charge Auditor - Full Time - Days

GENERAL SUMMARY:Coordinates payer denials and appeals, responds to insurance company requests for medical records, and performs medical record reviews.Responsibilities:Reviews medical records to determine accuracy of billing through verification of coding, billing and supporting clinical documentation. Coordinates all activities associated with insurance carrier audit requests and works with payers to ensure timely handling of these payer audits.|Reviews technical payer denials and determines whether an appeal is justified. Writes and tracks technical appeal letters and relays information to billing department.Conducts audits to ensure accurate charge capture, enhance reimbursement and identify savings potential.EDUCATION/EXPERIENCE REQUIRED: Diploma from an accredited school/college of nursing - -OR- Required professional licensure at time of hire. Bachelor's in nursing (BSN) preferred.Experience in medical record review, billing and coding accuracy and insurance carrier audit requests. Knowledge of billing and charging rules as it relates to clinical services is a plus. Computer skills (word processing, spreadsheet, graphics, and database software applications, especially Google Workspace, MS Office Suite). High level of comfort and ability to utilize and understand computer technology Proficient in the medical record: Review, clinical record information systems (Cerner/Epic a plus), and some coding methodologies. Ability to understand and interpret medical records, hospital bills, and the charge master. Ability to spot red flags on medical bills and records Ability to understand insurance terms (i.e. HMO/PP, EOB, stop loss, etc.) and payment methodologies 3-5 years' experience in hospital nursing, especially in one or more of the following areas: OR, L&D, Neuro-Surg, IR, ICU, ER, Ortho, Endo, Cardiac Cath, ICU, OR L&D, Neuro-surgery, Radiology, Interventional Radiology, ER and ability to understand all ancillary department functions.Experience in UR is a plusUnderstanding of CPT and ICD-10 codes and Medicare guidelines. Credentials in financial auditing or coding a plus Tasked with reviewing medical records and rendering independent, appropriate, well-supported, and thoroughly documented defenses when appropriate. Expected to research updates in current medical billing and coding processes and terminology specific to audit processes, clinical procedures, disease states, and other topics as indicated. Tasked with administrative duties as well as charge auditing and intake of payer requests and letters, including calling payers and accessing portals when needed.Conducts concurrent and retrospective claim audits to assure adherence to CMS and other payer guidelines. Communicates timely with Manager required regarding illness, appointments, vacation requests, changes in work schedule, performance barriers, and computer issues. Complies with department standards regarding productivity and audit quality. CERTIFICATIONS/LICENSURES REQUIRED: Registered Nurse credentialed from the Michigan Board of Nursing obtained prior to hire date or job transfer date required. Apply tot his job