Health Management Systems, Inc. Nurse Bill Auditor - 1099 Contractor - Virginia in VA, Virginia

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The Bill Auditor is responsible for auditing medical records of assigned cases. The primary focus of this position is to properly identify overpayments and possible underpayments through billed charges of reviewed records and to verify unbilled charges as presented by provider.

Essential Functions:

  • Under the supervision of Manager, Clinical Audits, the bill auditor, audits medical records and itemized bills to ensure billing accuracy for services provided and documented in the medical record.

  • Generates all potential review notices regarding denial

  • Evaluate bills assigned for audit and communicate with coordinator, if audit potential is poor.

  • Breakdown bills in preparation for audit if no breakdown provided.

  • Coordinate all audit activity with the appropriate hospital personnel to schedule and finalize audits

  • Abide by National Audit Review Guidelines to review bill and medical record.

  • Ensure consistent application of the guidelines during the review process for all functional components.

  • Complete progress reports to communicate timeline of audit process to coordinators and clients.

  • Participate in team meetings

  • Manage workload to ensure timely processing as per state and hospital mandates.

  • Participate in special projects as needed

Other Functions:

  • Performs other functions as assigned

Knowledge, Skills and Abilities:

  • Working knowledge of workflow management and electronic case file systems.

  • Ability to work proficiently with Microsoft Word, and Excel.

  • Ability to multi-task and prioritize work for self and direct reports as needed.

  • Ability to display excellent interpersonal skills with a customer service focus.

  • Average manual dexterity in use of a PC, phone, sorting, filing and other office machines.

  • Ability to work with basic mathematical concepts and calculate figures using calculator or adding machine.

  • Ability to receive direction and exhibit self-motivated initiative to accomplish tasks.

  • Ability to perform well in team environment, with staff at all levels, to achieve business goals.

  • Ability to meet deadlines and appropriately prioritize and manage multiple initiatives.

  • Working knowledge of HIPAA privacy and security rules.

  • Comprehensive understanding of hospital coding and billing techniques and revenue centers

  • Computer skills in a Windows and Citrix based environment

  • Ability to type 40 words per minute (WPM)

Work Conditions and Physical Demands:

  • Primarily sedentary work in a general office environment

  • Ability to communicate and exchange information

  • Ability to comprehend and interpret documents and data

  • Requires occasional standing, walking, lifting, and moving objects (up to 10 lbs.)

  • Requires manual dexterity to use computer, telephone and peripherals

  • May be required to work extended hours for special business needs

  • May be required to travel at least 10% of time based on business needs

Certifications: (Required/Desired)

  • Current RN Licensure required

  • AAMAS Certification preferred

Minimum Education:

  • Accredited RN Education Program required

Minimum Related Work Experience:

  • 3 year clinical experience

  • 1 year experience in line item review/audits of hospital bills

Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

Title: Nurse Bill Auditor - 1099 Contractor - Virginia

Location: Virginia-VA-Remote

Requisition ID: 170010V5