Maryland Licensed Nurse Auditor

Job Summary

To support the auditing of hospital bills, the full-time Maryland Licensed Nurse Auditor will conduct internal audits, collaborate with external auditors, and educate personnel on clinical reimbursement practices while working remotely.

Key responsibilities

• Conducts internal audits of patient service billings and identifies discrepancies in billing
• Communicates with external auditors and UMMS personnel to ensure compliance with audit policies
• Provides concurrent review of charge capture prior to claim submission to maximize reimbursement

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 negotiating skills and ability to communicate with insurance companies
• Proficiency in personal computer software, including spreadsheets and data management tools