Nurse Auditing Specialist

S1 Medical; Oregon; Ibrido; USD 90.000 - 120.000; Tempo pieno

Descrizione del lavoro

S1 Medical is seeking a Nurse Auditing Specialist to lead internal review of medical bills and ensure alignment with supporting documentation and guidelines. The NAS will leverage RN credentials to validate charges and help reduce unnecessary costs across multiple locations, working in a virtual environment.

The role requires meticulous documentation, collaboration with medical bill reviewers, and ongoing engagement with stakeholders to refine processes and educate providers.

Competenze

• Active RN license and credentials.
• Strong communication skills and professionalism.
• High attention to detail with thorough documentation.
• Ability to follow established protocols while using judgment.
• Excellent organizational and multitasking abilities in high-volume settings.
• Self-motivation in a virtual work environment.
• Collaborative mindset for cross-functional teamwork.

Mansioni

• Review medical bills against supporting documentation and notes.
• Verify costs with multiple medical pay data resources.
• Maintain clear, concise documentation for future reference.
• Provide instructions to auditors and negotiators based on audit findings.
• Collaborate with CBM-PM and CBS-PM to optimize workflow.
• Attend at least 2 events annually related to workplace culture or social initiatives.

Conoscenze

RN license

Self-motivated

Excellent communication

Attention to detail

Organizational skills

Collaborative mindset

Decision making

Virtual work

Formazione

Active RN license

Descrizione del lavoro

About the Role

The Nurse Auditing Specialist ("NAS") is the lead resource within S1 Medical to review medical bills of certainsize or type and attempt to identify any medical bill charges or practices that are not in line with the support medical documentation, the injury itself, or comparable commercially reasonable reimbursement referencetools. Additionally, the NAS will aid in the review of medications being authorized against Medicare medicalguidelines.

The role of the NAS is important for multiple reasons:

• Directly supports the launch of an internalized role and process at S1.
• Directly involved in the most cost-effective area of the client's medical spend.
• Provides S1 with its first internal clinical resource for staff.

Role and Responsibilities

Core responsibilities include, but are not limited to the following:

• Represent S1 as an internal clinical resource, maintaining necessary RN credentials and licensures.
• Utilize nursing experience to review supporting documentation that accompany medical bills. Ensuremedical billing is aligned with medical notes.
• Utilize multiple medical pay data resources to validate the cost of medical charges as presented onmedical bills.
• Collaborate with CBM-PM to ensure a smooth workflow to accomplish bill auditing steps.
• Collaborate with CBS-PM to establish and refine a personal "style" & strategy related to reducing thecosts of medical charges, explaining the reasons for medical charge reduction, and communicatingwith medical providers and facilities when needed.
• In an organized and systematic fashion, keep up on clear and concise documentation of findings sothat they are referenceable in the future. There will be multiple locations where documentation is required.
• Provide clear and deliberate instructions to medical bill auditors and negotiators as it relates to youraudit findings, and these being transferred into medical bill review system or communicated toproviders.
• Maintain a process of self-management and organization so that both individual medical bills, as well as tasks associated with those medical bills, are not lost.
• Attend at least 2 events annually related to workplace culture improvement and/or the role of business in progressing social or environmental initiatives.

What We Are Looking For

• Active Registered Nurse (RN) license and credentials
• Self motivated, especially in a virtual work environment
• Proven ability to make sound, timely decisions and/or ask for support when needed
• Excellent communication skills, with the ability to interact clearly and professionally
• High attention to detail with accurate and thorough documentation skills
• Ability to follow established protocols while exercising judgment when needed
• Strong organizational and multitasking abilities in a high-volume environment
• Collaborative mindset with the ability to work cross-functionally with team members

Why Join Us?

This is an opportunity to play a key role in a growing organization, directly contributing to client satisfaction and organizational success. You'll work in a supportive environment where accuracy, accountability, and collaboration are highly valued. S1 Medical offers a competitive salary and comprehensive benefits package with this position.