Maryland Licensed Nurse Audit Specialist

Job Summary

To ensure minimal uncompensated patient revenues, the full-time Maryland Licensed Nurse Audit Specialist will conduct internal audits of hospital bills, collaborate with external auditors, and educate personnel on clinical reimbursement practices in a remote environment.

Key responsibilities

• Conduct audits of patient medical records and billing to identify discrepancies and negotiate with external auditors
• Gather and record data for performance reporting, ensuring the integrity of information
• Communicate with various stakeholders to align on audit policies and assist in the appeals process for denied claims

Required qualifications

• Current active RN registration with the Maryland State Board of Nursing
• Four years of professional nursing experience, including two years in Utilization Review, Quality Assurance, or Case Management
• Knowledge of hospital review procedures and third-party payment processes
• Effective negotiation skills and ability to apply clinical assessment skills to audits
• Proficiency in personal computer software, including spreadsheets and word processing