Hospital Bill Audit Nurse I

CorVel Corporation; Oregon; Hybrid; USD 64,000 - 95,000; Full time

Job summary

CorVel Corporation seeks a Hospital Bill Audit Nurse to conduct hospital bill charge audits by reviewing medical records and validating charges. Travel to provider locations is required, and audits may include inpatient, outpatient, NICU, and hospice settings.

The role emphasizes accuracy, HIPAA compliance, and collaboration with the Audit Coordinator to ensure timely, thorough audits and professional representation of CorVel/CERIS.

Qualifications

• Associate degree in nursing or higher is required.
• Current RN licensure in the state of employment is required.
• Experience in hospital billing/audit preferred (external or internal).
• Minimum five years in OR/ICU/ER as RN preferred; hospice experience a plus.

Responsibilities

• Schedule and complete audits efficiently; travel onsite as needed.
• Review medical records to verify services and charges.
• Identify overcharges/undercharges and unbundled items.
• Document findings with standard guidelines; ensure HIPAA compliance.
• Communicate with Audit Coordinator and manager; escalate issues as needed.

Skills

Hospital billing

CMS guidelines

Communication skills

MS Office / Excel

Attention to detail

Organizational skills

Independent work

Travel onsite

Education

Associate Degree in Nursing or higher

RN licensure in state of employment

Tools

Microsoft Excel

Job 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 role is responsible for independent scheduling requiring flexibility and travel to provider location.

ESSENTIAL FUNCTIONS & RESPONSIBILITIES:

• Acknowledge assigned work, 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, routine services, and equipment/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 during an audit
• Report any problems in the auditing 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 as assigned
• Onsite scheduling and travel

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
• Excellent written and verbal communication skills necessary to interact positively with both external and internal customers
• 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
• Ability to handle stressful situations and adapt accordingly
• Ability to work in a fast-paced environment
• Ability to 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.For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.

Pay Range: $63,739 - $95,264

A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk ManagementIn general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.

• 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
• paid time off

About CERISCERIS, 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!).

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