Nurse Audit Specialist: Revenue Integrity & Insights

University of Maryland Medical System; Linthicum (MD); On-site; USD 80,000 - 110,000; Full time

Job summary

University of Maryland Medical System in Linthicum, MD, seeks an experienced nurse auditor to conduct internal audits of hospital bills with external auditors, aiming to minimize uncompensated patient revenues.

The role informs UMMS personnel about reimbursement results and practices, reviews records for billed vs rendered services, and negotiates billing issues with payers to improve financial outcomes.

Qualifications

• Current active RN registration with the Maryland State Board of Nursing.
• Four years professional nursing experience with Utilization Review/QA/Case Management.
• Knowledge of hospital review procedures and third party payment.
• Ability to interpret guidelines and communicate with insurance companies.

Responsibilities

• Plans work for self and with coworkers, prioritizes tasks across clinical audit activities.
• Evaluates patient records vs billed charges to identify discrepancies and totals.
• Negotiates with external auditors regarding billing issues.
• Submits audit documentation timely and coordinates with departments for documentation.
• Communicates with external payers, UMMS personnel, and regulators to ensure policy alignment.
• Provides concurrent review of charge capture to maximize reimbursement.

Skills

RN license

Utilization Review

Quality Assurance

Case Management

Negotiation

Data analysis

Audit process

Communication skills

Microsoft Excel

Education

Registered Nurse (RN) license

Maryland State Board of Nursing License

Tools

MIDAS software

Excel

Job description

University of Maryland Medical System in Linthicum, MD, seeks an experienced nurse auditor to conduct internal audits of hospital bills with external auditors, aiming to minimize uncompensated patient revenues.

The role informs UMMS personnel about reimbursement results and practices, reviews records for billed vs rendered services, and negotiates billing issues with payers to improve financial outcomes.