Illinois Licensed Nurse Auditor

Job Summary

To maximize client savings, the full-time Illinois Licensed Nurse Auditor will remotely review medical bills, ensuring appropriate billing, coding, and treatment while maintaining compliance with fee schedules and identifying erroneous charges.

Key responsibilities

• Audit medical and billing records to assess the reasonableness and necessity of services provided
• Clinically identify and evaluate charges unrelated to the occurrence and verify compliance with authorized services
• Initiate contacts with clients and medical providers as necessary and negotiate bills when required

Required qualifications

• Active RN (or LPN) professional license or equivalent within states of operation
• CPC and/or CPC-H certification(s) strongly desired
• 3-5 years of clinical experience in acute care, surgery, and/or orthopedics
• Understanding of CPT and ICD-10 codes and Medicare guidelines
• Experience in Workers' Compensation medical bill review is a major plus