Pennsylvania Licensed Nurse Auditor

Job Summary

A company is looking for a Nurse Auditor.

Key Responsibilities

• Functions as a liaison with third-party billing and auditing firms, managing audit appeals and denials
• Reviews and analyzes audits, develops action plans to reduce denials, and provides education on correct charging procedures
• Collaborates with management and physician advisors to resolve audit disputes and ensure compliance with regulations

Required Qualifications

• Specialized Diploma in nursing
• 10 years of clinical experience
• Ability to read medical charts and identify documentation deficiencies
• Knowledge of medical policy per payor guidelines and hospital-based charging methods
• RN - Licensed Registered Nurse in Pennsylvania upon hire