Hospital Bill Audit Nurse I

CERIS; Texas; Remote; USD 60,000 - 90,000; Full time

Job summary

An innovative company is seeking a Hospital Bill Audit Nurse I to join their remote team. This role involves conducting thorough audits of hospital billing, ensuring accuracy and compliance with medical documentation and industry standards. The ideal candidate will possess a keen understanding of hospital billing practices, including UB-04 and ICD10 codes, and have excellent communication and organizational skills. You will have the flexibility to work independently while traveling to provider locations as needed. Join a forward-thinking organization that values attention to detail and critical thinking in a supportive and dynamic environment.

Qualifications

• Associate Degree in Nursing or higher with current RN licensure.
• 5+ years experience in OR, ICU, or ER as an RN preferred.

Responsibilities

• Conduct hospital bill charge audits by reviewing medical records.
• Identify discrepancies such as overcharges and undercharges.
• Document findings and ensure compliance with regulations.

Skills

Hospital billing understanding

Knowledge of CMS and payor guidelines

Microsoft Office proficiency

Attention to detail

Organizational skills

Critical thinking skills

Excellent communication skills

Education

Associate Degree in Nursing

Current RN licensure

Previous medical bill audit experience

5+ years experience in OR, ICU, or ER

Tools

Microsoft Excel

Job description

Join to apply for the Hospital Bill Audit Nurse I role at CERIS

This position involves conducting hospital bill charge audits by reviewing medical records to verify that services were provided and charges are appropriate according to medical documentation and industry guidelines. Audits may include inpatient, outpatient, NICU, and hospice services. The role requires identifying overcharges, undercharges, and unbundled items per payor contracts and industry standards. The candidate must be able to work independently, with flexible scheduling and travel to provider locations. This is a remote position.

Essential Functions & Responsibilities

• Schedule and travel onsite as needed to perform audits, maintaining timely communication with the Audit Coordinator
• Review medical records to verify service provision and charge accuracy
• Identify discrepancies such as overcharges, undercharges, errors, duplicates, and unbundled items
• Document findings according to standard guidelines
• Report problems and ensure compliance with HIPAA and other regulations
• Represent CERIS professionally and uphold company policies

Knowledge & Skills

• Understanding of hospital billing including UB-04, revenue codes, CPT/HCPCS, ICD10 codes
• Knowledge of CMS, payor, and industry guidelines preferred
• Proficiency in Microsoft Office, especially Excel
• Attention to detail, organizational and critical thinking skills
• Excellent communication skills and ability to work independently

Education & Experience

• Associate Degree in Nursing or higher
• Current RN licensure in the state of employment
• Previous medical bill audit experience preferred
• At least 5 years’ experience in OR, ICU, or ER as an RN highly preferred