Maryland Licensed Nurse Auditor

Job Summary

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

Key responsibilities

• Conducts comprehensive audits of patient medical records and billing to identify discrepancies and negotiate with external auditors
• Gathers and records data for performance reporting while ensuring the integrity of recorded information
• Communicates with various stakeholders to ensure compliance with audit policies and assists in the appeal process for denied claims

Required qualifications

• Current active RN registration with the Maryland State Board of Nursing
• Four years of professional nursing experience in a patient care setting
• Two years of experience in Utilization Review, Quality Assurance, or Case Management
• Knowledge of hospital review procedures and third-party payment systems
• Proficiency in using personal computers and related software, including spreadsheets and database management