Remote Bill Review Audit Nurse Specialist

Job is Expired
Location: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Puerto Rico, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, U.S. Virgin Islands, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming
Compensation: Salary
Staff Reviewed: Fri, Jul 08, 2022
Job Summary
Under the direction of the Provider Network Manager, the Bill Review Nurse Specialist is responsible for utilizing clinical acumen and medical review/audit expertise related to reviewing workers' compensation medical bills, including but not limited to: reviewing medical records, itemized statements and other documentation to perform retrospective review/audit of high dollar, complex procedure and/or other at risk bills as determined by Provider Network Manager and AVP of Bill Review Services.

This position requires experience in auditing complex medical bills from inpatient/outpatient hospitals, ASC (Ambulatory Surgery Center), surgeons, assistant surgeons, and specialist bills etc.

The Bill Review Nurse Specialist performs a complete review of medical records associated with the bill and a line-by-line thorough audit of the itemized bill and other documentation scrutinizing for the following:

- Potential billing errors
- Charges not supported by documentation
- Charges not related to the work comp injury (if the accepted injury is available to us)
- Charges that should not be unbundled
- Diagnosis Related Group Validation
- Implant verification/proof of service
- Correct use of CPT, Diagnosis, Procedure, HCPCS codes as well as modifiers
- Unlisted or BR code verification and/or re-pricing
- Other items as determined by the Provider Network Manager and/or AVP of Bill Review Services

Requirements:
- LPN or RN with an active and unencumbered license
- Minimum five years clinical nursing experience
- Minimum 3 years' experience in performing complex Work Comp Medical Bill Nurse Audit reviews with provider relations exposure preferred
- Knowledge of ICD-9/10, HCPCS ,CPT, Modifier & DRG coding procedures

EK Health offers a family atmosphere, work/life balance and benefits including: medical, dental, vision, 401K, accrued PTO and 7 paid holidays.

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