Hospital Bill Audit Nurse I

CERIS; Fort Worth (TX); Remote; USD 62,000 - 94,000; Full time

Job summary

An established industry player is seeking a Hospital Bill Audit Nurse I to join their remote team. This role involves conducting thorough audits of hospital bills, ensuring accuracy in charges and compliance with industry standards. The ideal candidate will possess a strong understanding of hospital billing, exceptional attention to detail, and the ability to work independently in a fast-paced environment. As part of a supportive culture, you will have opportunities for career advancement while contributing to the integrity of healthcare payments. If you're passionate about making a difference in healthcare, this is the perfect opportunity for you.

Benefits

Medical (HDHP) with Pharmacy

Dental Insurance

Vision Insurance

Disability Insurance

401K

Paid Time Off

Flexible Spending Accounts

Life Insurance

Legal Insurance

Parking and Transit FSA

Qualifications

• 5+ years experience in OR, ICU, or ER as an RN preferred.
• Previous medical bill audit experience is highly preferred.

Responsibilities

• Conduct hospital bill charge audits by reviewing medical records.
• Document unsupported charges identified during audits.
• Travel onsite as needed to perform audits.

Skills

Knowledge of hospital billing/charging

CPT/HCPCS codes

ICD10 diagnosis and procedure codes

Proficiency in Microsoft Office

Exceptional attention to detail

Professional communication skills

Ability to work independently

Education

Associate Degree in Nursing

Current RN licensure

Tools

Microsoft Excel

Job description

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Description

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.

Job Details

This is a remote position.

Essential Functions & 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 & 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
• Proficiency in Microsoft Office applications including Excel
• Exceptional attention to detail
• 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, with salary ranges varying by location. Pay rates are based on factors including minimum wage requirements, geographic location, skills, experience, qualifications, internal equity, and market conditions. Ranges may be adjusted at any time.

For leveled roles (I, II, III, Senior, Lead, etc.), new hires may be slotted into different levels based on the interview assessment, affecting salary ranges. These details will be clarified during the offer process.

Pay Range: $62,306 – $93,123

About CERIS

CERIS, a division of CorVel Corporation, a certified Great Place to Work company, offers value, experience, and dedication to partners. We focus on accuracy and transparency in healthcare payments through clinical expertise and cost containment solutions. We are a stable, growing company with a supportive culture and career advancement opportunities, embracing core values of Accountability, Commitment, Excellence, Integrity, and Teamwork (ACE-IT!).

Our full-time employees enjoy benefits including Medical (HDHP) with Pharmacy, Dental, Vision, Disability, Health Savings Account, Flexible Spending Accounts, Life Insurance, Accident and Critical Illness Insurance, Legal Insurance, Parking and Transit FSA, 401K, Roth 401K, and paid time off.

We are an Equal Opportunity Employer, drug-free workplace, and compliant with ADA regulations.