A Day in the Life of a Nurse Auditor:

The Nurse Auditor reviews medical records for hospital clients to review including denials, disallowed charges and more for the facility. This position may perform specialized administrative duties pertaining to hospital billing and reimbursement activities, utilizing a knowledge of both nursing and administrative practices. Nurse Auditors perform medical bill and defense audits, and review grievances and claim denials. May recommend appeals and/or facilitate resolutions.

Why Work at Cheyenne Regional?

• ANCC Magnet Hospital
• 403(b) with 4% employer match
• 21 PTO days per year (increases with tenure)
• Education Assistance Program
• Employer Sponsored Wellness Program
• Employee Assistance Program
• Loan Forgiveness Eligible

Here Is What You Will Be Doing:

• Performs audits on RAC accounts by comparing the charges against all necessary clinical documentation and recommend appeals and/or facilitates the resolution of the root causes where appropriate.
• Writes appeal letters for all denials and sends results to RAC coordinator for follow through procedures.
• Performs audits on paid managed care accounts where an external auditor has identified discrepancies (Defense Audits) by reviewing charges originally billed against the necessary clinical documentation to identify any possible under/over charges.
• Documents and send audit results to biller, external auditors, and facility department managers as needed for review.
• Performs charge and dispute audits as requested by patients. Review charges and compare to necessary clinical documentation. Document results and forward results to Patient Financial Services for patient follow up.
• Collaborates with various staff and departments/units to obtain necessary audit information and timely education to improve deficient processes.
• Maintains positive customer relations; research and investigate issues; prepare written or oral responses as needed.
• Conducts special studies and projects as assigned; research and analyze information; prepare statistical and narrative reports and documents as needed.
• Promotes and participates in LEAN practices and strategies.

Desired Skills:

• Thorough knowledge of nursing practices in an acute care setting
• Knowledge of medical terminology, common diseases, and conditions/treatments
• Knowledge of reimbursement and insurance practices common to the healthcare industry
• Knowledge of coding and billing such as E/M level charges, and coding for DRG audits
• Knowledge of applicable laws, regulation, requirement, standards and practices pertaining to patient confidentiality
• Ability to read and understand patient medical records and other treatment documents
• Ability to identify discrepancies between medical information and financial charges.
• Ability to analyze and resolve problems and complaints
• Proficient knowledge of Microsoft Office and other required applications
• Excellent verbal, written, and interpersonal communication skills.
• Ability to establish and maintain cooperative working relationships
• Knowledge of the state’s Medicaid and Medicare guidelines

Here Is What You Will Need:

• Wyoming Registered Nurse (RN) License or enhanced Nurse Licensure (eNLC)
• Five (5) or more years of clinical experience
• Two (2) or more years of experience performing utilization review, charge audits, case management, clinical documentation or similar functions in an acute care hospital

Nice To Have:

• Experience with Epic applications
• Experience in medical coding
• Medical coding certification
• About Cheyenne Regional:

Cheyenne Regional Medical Center was founded in 1867 as a tent hospital by the Union Pacific Railroad to treat workers injured while building the transcontinental railroad. Today, we are the largest hospital in the state of Wyoming, employing over 2,000 people, and treating over 350,000 patients from southeastern Wyoming, western Nebraska, and northern Colorado. We pride ourselves on patient and employee experience by living our core values of Integrity, Caring, Compassion, Respect, Service, Teamwork and Excellence to I.N.S.P.I.R.E. great health.

Our team makes a difference every day by providing trusted healthcare expertise through a passionate and I.N.S.P.I.R.E.(ing) approach with a personal touch. By living our values, we aim to achieve our goal of becoming a 5-star rated hospital, providing critical support and resources to our community and the greater region we serve. If you are eager to make a difference and passionate about healthcare, we encourage you to apply today!