Quality Assurance Nurse Auditor / Nurse Analyst / Coding Auditor

Greater North Fulton Chamber of Commerce; Charlotte, Tampa, Nashville, Atlanta, Knoxville (NC, FL, TN, GA, TN); On-site; USD 60,000 - 100,000; Full time

Job summary

Join a dynamic and innovative firm as a Quality Assurance Nurse Auditor, where your expertise in acute care and clinical documentation will shine. This role involves providing essential advisory services to various healthcare organizations, ensuring compliance with medical necessity and billing documentation standards. You'll collaborate with a talented team to deliver exceptional client solutions while managing projects effectively. With a strong national reputation and commitment to professional growth, this is an exciting opportunity to make a significant impact in the healthcare consulting field. Embrace the chance to work with industry leaders and advance your career in a supportive environment.

Benefits

Competitive Compensation

Comprehensive Benefits

Opportunities for Career Advancement

Qualifications

• 5+ years in acute care review, nurse analyst, or CDI.
• CPC, COC, CCS, or CCS-P certification required.

Responsibilities

• Provide advisory services for medical necessity and documentation improvement.
• Assist with coding compliance reviews and regulatory compliance.

Skills

Acute Care Medical Necessity Review

Clinical Documentation Improvement (CDI)

Utilization Review (UR)

Project Management

Written and Oral Communication

Creative Problem Solving

Education

Active LPN or RN License

CPC, COC, CCS, or CCS-P Certification

Tools

McKesson InterQual

Milliman

Microsoft Office Suite

Job description

Quality Assurance Nurse Auditor / Nurse Analyst / Coding Auditor

PYA is seeking a Quality Assurance Nurse Auditor/Nurse Analyst/Coding Auditor to join its high-performing and privately-owned firm with a dynamic culture and a strong national reputation. This individual will be a member of the Revenue and Compliance Advisory Team.

RESPONSIBILITIES

1. Provide advisory services to ambulatory care, acute care, and post-acute care organizations, including documentation review and improvement for:
1. Medical Necessity
2. Level of Care
3. Appropriateness of service and service location
4. Billing documentation requirements and analysis of UB-04, Remittance Advices and Itemized Bills
2. Assist with coding compliance reviews including professional, hospital outpatient, and inpatient hospital services
3. Assist with regulatory compliance for Medicare, Medicaid, and third-party payers to include ambulatory, acute care (inpatient and outpatient), rehabilitation, and behavioral health services
4. Perform research and interpret applicability of National Coverage Determination and Local Coverage Determination
5. Work in collaboration with the PYA executive team and other service lines to offer complete business solutions to clients
6. Manage the preparation of excellent client deliverables and exhibit exceptional project management skills while balancing firm risk and compliance with appropriate professional standards

QUALIFICATIONS

1. 5+ years of experience in acute care medical necessity review, nurse analyst, clinical documentation improvement (CDI), and/or utilization review (UR)
2. CPC, COC, CCS, or CCS-P required
3. Active LPN or RN license
4. Adept knowledge in McKesson InterQual and/or Milliman, Microsoft Office Suite and working knowledge of Medicare A&B
5. Excellent written and oral communication skills
6. Creative problem solver with a high level of strategic, analytical, and conceptual skills with a passion for helping clients
7. Demonstrated ability in project management

ABOUT PYA

PYA, a leading professional services firm, serves clients across the United States with expertise in healthcare consulting, accounting, compliance, and business strategy. With offices in Knoxville, Atlanta, Tampa, Charlotte, Nashville, and Kansas City, PYA is committed to helping clients achieve their goals through innovative solutions and unparalleled service. Learn more about The PYA Way.

Why Join PYA?

1. Be part of a dynamic and collaborative team that values innovation and excellence
2. Work with industry leaders who are committed to professional growth and client success
3. Competitive compensation, comprehensive benefits, and opportunities for career advancement