Licensed Nurse Auditor

Job Summary

Conducting hospital charge audits remotely, the Licensed Nurse Auditor will verify the appropriateness of charges on claims, identify discrepancies, and manage audit scheduling while requiring flexibility for possible travel.

Key responsibilities

• Review medical records to ensure services billed were actually provided during Hospital Bill Audit reviews
• Identify overcharges, undercharges, and unbundled items according to payer Unbundling Guidelines
• Manage audit scheduling and maintain communication with the Audit Coordinator regarding audit completion and submission

Required qualifications

• Minimum of 5+ years of acute care clinical experience in medical/surgical units
• Current active license as a Licensed Nurse
• At least 3+ years of hospital bill auditing experience on high dollar claims
• CPC, CCS, or CMAS certification desired
• Proficiency in Excel and familiarity with basic data entry tasks