[Hiring] Nurse Auditor @Ensemble Health Partners

Role Description

• The Nurse Auditor I performs charge audits and potential client assessments as assigned by management. This role is responsible for timely resolution of all incorrect and/or missing charges to prevent revenue loss and to ensure compliance requirements are met.
• Identifies opportunities for any additional documentation needs to support charges captured.
• Conducts regular audits to look for opportunities of missing revenue and reports to management.
• Fulfill audits requests by reviewing clinical documentation, identify trends for missing and/or incorrect charges and report on findings.
• Applies clinical knowledge to educate stakeholders on standards for documentation and charge capture practices and to look for opportunities of improvement based on audit outcomes.
• Responsible for reviewing Injection & Infusion work queues in Epic.
• Resolve prebill and post bill missing and error charges identified by Opera Solutions software to prevent revenue loss and ensure accurate and timely billing of services provided.
• Support the organization in meeting its financial goals. Travel to clients’ sites as needed to conduct assessments and to provide education and training related to findings.
• Respond to clients’ questions and audit requests in a timely manner.
• Meet and or exceed the department productivity and quality standards.
• Review CMS, OIG, and other pertinent government websites to keep abreast of all charge capture guidelines & how they may impact revenue.
• Maintain thorough understanding of government rules and regulations, generally accepted auditing standards and common audit procedures and techniques.
• Qualifications
• Current RN or LPN Licensure
• Working knowledge of CPT/HCPCS/Revenue codes, charge capture and billing best practices, and government and non-government reimbursement guidelines.
• Strong organization skills.
• Highly motivated and self-starter with ability to complete assignments within time constraints and deadlines.
• Ability to thrive in a dynamic & fast paced work environment.
• Experience in physician and hospital operations, compliance and provider relations.
• Requirements
• Candidate must have and keep current at least one of the following professional certifications or other approved job relevant certification
• CCDI (Certified Clinical Documentation Improvement)
• CCS (Certified Coding Specialist)
• RHIA (Registered Health Information Administrator)
• RHIT (Registered Health Information Technician)
• COC (Certified Outpatient Coder)
• PMP (Project Management Professional)
• CPMA (Certified Professional Medical Auditor)
• Benefits
• Comprehensive benefits package designed to support the physical, emotional, and financial health of you and your family, including healthcare, time off, retirement, and well-being programs.
• Investment in professional development with opportunities for earning professional certifications relevant to their field and tuition reimbursement.
• Quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company.