The Hospital Bill Audit Nurse conducts hospital bill charge audits by reviewing medical records to verify that services were provided and charges are appropriate based on medical documentation and industry guidelines. The types of audits performed could include, but are not limited to inpatient, outpatient, NICU, and hospice. Charge audits identify overcharges, undercharges, and unbundled items per payor contract and industry standards. This candidate will be responsible for independent scheduling requiring flexibility and travel to provider location.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:

• Onsite scheduling and travel – acknowledge work that is assigned, maintain timely communication with Audit Coordinator, schedule and complete audits in an efficient and timely manner.
• Travel onsite as needed to perform audits.
• Review medical records to verify services were provided and charges are accurate – Identify overcharges, undercharges, unbundled items, errors, duplicates, and routine services, equipment and supplies.
• Identify discrepancies if they exist and document the findings using standard documentation guidelines applicable to the position.
• Understand audit and data information to make decisions with accurate results.
• Document all unsupported charges identified in the course of an audit for each case.
• Report any problems in the audit process to the manager and/or supervisor for resolution.
• Comply with all HIPAA and other regulations regarding the confidentiality of patient information.
• Comply with all provider and internal policies and guidelines.
• Must represent CorVel/CERiS in a professional and knowledgeable manner.
• Additional duties/responsibilities as assigned by manager and/or supervisor.

KNOWLEDGE AND SKILLS:

• Knowledge and understanding of hospital billing/charging including UB-04’s, itemized bills, revenue codes, CPT/HCPCS codes, ICD10 diagnosis and procedure codes.
• Strong working knowledge of CMS, payor, and other industry guidelines preferred.
• Computer skills necessary to manage correspondence, information entry and retrieval from system, and the ability to create and participate in virtual meetings.
• Reasonable proficiency in Microsoft office applications including Excel.
• Exceptional attention to detail.
• Must have advanced organizational, strategic, and critical thinking skills.
• Excellent professional communication skills necessary to interact positively with both external and internal customers.
• Ability to handle stressful situations and adapt accordingly.
• Ability to work in a fast paced environment.
• Ability to think and work independently.

EDUCATION & EXPERIENCE:

• Associate Degree in Nursing or higher required.
• Must maintain current licensure as a Registered Nurse in the state of employment.
• Previous external or internal medical bill audit experience highly preferred.
• Minimum of 5 years’ experience in the OR, ICU, or ER as an RN highly preferred.
• Hospice experience a plus

PAY RANGE:

CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.

Pay Range: $60,846 – $90,940

A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management

About CERIS

CERIS, a division of CorVel Corporation, a certified Great Place to Work® Company, offers incremental value, experience, and a sincere dedication to our valued partners. Through our clinical expertise and cost containment solutions, we are committed to accuracy and transparency in healthcare payments. We are a stable and growing company with a strong, supportive culture along with plenty of career advancement opportunities. We embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.

CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.