Career Opportunities
This service is available to employers and our members but is not an AAMAS endorsement of the employers or positions advertised. If you wish to place an advertisement on this page please email .(JavaScript must be enabled to view this email address)
Nurse Auditor
Discover a new opportunity.
Loma Linda University Medical Center (LLUMC) seeks an experienced Nurse Auditor for third party detailed chart audit review (Health Plan/Medical Group), LLUMC Legal Department, PBO Director and Managers. Audits patient billing for accuracy and coordinates with staff, physicians, health plans, and revenue cycle departments on issues related to accuracy of the charge and coding processes. Prepares pre-billing charge capture for identified cases and establishes documentation methods plus tracking, and communicating findings.
Requires Associate’s degree in nursing and three plus years in case management or discharge planning, UR, or internal audit. RN experience in an acute care setting is essential. BSN and at least five years experience in charge and billings processes, and payer or CMS billing requirements preferred. Active CA RN License is necessary and current certification as a Certified Healthcare Chart Auditor preferred.
Must have strong knowledge of medical terminology, charge description master, medical records charting, universal billing and line item review, plus in-depth understanding of acute hospital charge and posting practices, coding, insurance billing and industry regulations and ability to interpret health plan contract terms.
LOMA LINDA UNIVERSITY MEDICAL CENTER
Please visit our website at http://www.careers.llu.edu and search for position #41806. eoe/aae
Nurse Auditor (Consultant)
StrataCare is a leader in national bill review software solutions and service for the workers' compensation industry. The StrataWare suite utilizes the latest browser-based technology to deliver an integrated solution that helps our clients lower costs, improve productivity, increase profits, and meet regulatory or governmental compliance.
Our flexible and user-friendly solutions allow you to manage workers' compensation bill review in-house or outsource through our CareSolutions National Bill Review Service Center. StrataCare's staffs are experts in workers' compensation bill review and are committed to delivering a complete solution that meets the unique needs of our clients, which include insurance companies, self insured employers and third party administrators. http://www.stratacare.com
Position Summary:
Responsible for performing retrospective surgery and hospital bill audits to ensure billed charges are substantiated by medical records, identify coding errors, duplicate charges, and bundling and unbundling errors.
Main Duties and Responsibilities:
- Review Workers’ Compensation medical bills
- Determine procedure code appropriateness and accuracy for the injury and diagnosis
- Evaluate and compare services billed to supporting documentation to ensure billed services were actually performed
- Verify levels of service and procedures billed correspond with the accompanying documentation
- Conduct medical record review and DRG validation on hospital billings when appropriate
- Handle provider communications of appeals
- Appear at Workers’ Compensation Appeals Board as Expert Witness
Qualification Guidelines:
- Current RN license from an accredited hospital program, college or university is required
- Experience and working knowledge of current medical terminology, treatment modalities, diagnostic studies, medications, and additional services rendered by various types of providers
- Knowledge and understanding of state and federal compliance regulations, Medicare guidelines, DRG, CPT and ICD-9 coding, and healthcare programs in general
- 2 years Hospital Desk Audit experience required
- 3 years experience in the OR, Med/SURG, ICU, or ER required
- Coding Certificate a plus
- Excellent interpersonal, oral and written communications skills
- Good organizational and time management skills
- Ability to work independently
