Nurse Auditor
Jzanus Consulting
Garden City, NY
- Eligibility
- RNClinical Documentation & Utilization Review NursesAdministrative & Consulting Nurses
Ask Mira
Posted Sep 26, 2024
The work and the unit
- Specialty
- Clinical Documentation & Utilization Review Nurses · Administrative & Consulting Nurses
- Setting
- Hospital
Staffing and support
The posting does not state the assignment size, and nothing published names it for this unit.
Schedule and commitments
- Weekends
- No weekends
- Term
- Permanent
Do you qualify?
- License
- Registered Nurse licensed in New York preferred.Preferred Check your license
- Education
- Associates or Bachelor of Science in Nursing required.
- Experience
- 3+ years’ experience in hospital setting preferred.Preferred
- Experience
- Auditing experience preferred.Preferred
- Experience
- Experience with PCs, word processing, spreadsheet, graphics, and database software applications is desired.Preferred
- Also asks
- Strong Computer and software skills required for effective remote work.
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- Also asks
- Ability to work independently & cooperatively, efficiently, and accurately prioritizing varying workloads required.
- Also asks
- Strong quantitative, analytical, and organization skills required.
- Also asks
- Must be able to understand all ancillary department functions.
- Also asks
- Must be able to understand insurance terms (i.e. HMO/PP, EOB, stop loss, etc.) and payment methodologies. Excellent communication skills required. Positive attitude to work effectively with staff and clients required.
- Also asks
- Knowledge of CPT/HCPCS procedural coding and Charge Description Masters strongly preferred.Preferred
- Also asks
- SPECIFIC
What's around it?
Living costs about 8% above the US average
- Median rent
- $3,265/mo
- Household income
- $244,152/yr, all local households, not nurse pay
From Census ACS 2024.
About this role
The Nurse Auditor will have full responsibility to audit patient charts (i.e., medical record) and respond to insurance denials. The audit is conducted to ensure that the clinical documentation contained within the patient chart supports items and services that appear on the patient’s bill, and to ensure that all items and services provided are included on the patient bill. Where clinical documentation does not support items appearing on the bill, the Nurse Auditor will prepare a report of exceptions and offer solutions. The Nurse Auditor will ensure complete and timely responses to the requestor of the audit.
Qualifications
Associates or Bachelor of Science in Nursing required.
Strong Computer and software skills required for effective remote work.
Read the full posting
Registered Nurse licensed in New York preferred.
3+ years’ experience in hospital setting preferred.
Auditing experience preferred.
Knowledge of CPT/HCPCS procedural coding and Charge Description Masters strongly preferred.
Experience with PCs, word processing, spreadsheet, graphics, and database software applications is desired.
Ability to work independently & cooperatively, efficiently, and accurately prioritizing varying workloads required.
Strong quantitative, analytical, and organization skills required.
Must be able to understand all ancillary department functions.
Must be able to understand insurance terms (i.e. HMO/PP, EOB, stop loss, etc.) and payment methodologies. Excellent communication skills required. Positive attitude to work effectively with staff and clients required.
Specific
Essential functions
Additional Skill Set(s) Required
- Coordinates all procedural and other elements related to the Centers for Medicare & Medicaid Recovery Audit Contractor program, commercial payor audits, patient requested audits and charge capture auditing.
- Audits and reconciles services and items included in the patient’s chart with services and items included on the patient’s bill in a timely manner. Where exceptions are noted, suggested solutions are offered.
- Identifies and prepares charges to be corrected on accounts.
- Pre-reviews accounts being audited by Government Agencies.
- Meets required timelines for all audit activities.
- Works fluidly with Audit Team to communicate audit results.
- Reviews medical records for accuracy and billing compliance as support for billers and coders, for medical necessity and where appropriate works through the hospital HIM and financial departments to identify physician and clinic practices that require improved documentation.
- Organizes and reconciles daily work drivers to ensure accountability of all audits assigned and to ensure audits are worked in proper priority.
- Keeps updated on various billing rules to ensure charges that are identified in audits are split and rebilled properly.
- Conducts trend analyses to identify patterns in audit requests and outcomes for medical necessity, coding and billing practices.
- Functions as a liaison to resolve any related charge/coding issues or problems that occur in or are identified during the audit process.
- Instructs and teaches. Performs ancillary service quality assurance reviews and audits, and meets with the Managers and staff to instruct and inform on documentation findings to increase accuracy in billing; recommends solutions to improve charge capture accuracy.
- Excellent communication skills necessary to deal with many departments regarding billing issues and required solutions.
- Performs other duties as assigned.
Job Type: Full-time Pay: From $87,000.00 per year
Benefits
401(k)
401(k) matching
Dental insurance
Flexible schedule
Health insurance
Life insurance
Paid time off
Vision insurance
Schedule
Monday to Friday
License/
Certification
RN License (Required)
Ability to Relocate
West Hempstead, NY 11552: Relocate before starting work (Required) Work Location: Hybrid remote in West Hempstead, NY 11552
About Jzanus Consulting
For over 25 years, Jzanus has been a premier provider of revenue integrity HIM services. Quality and trust, along with personal and professional integrity have been the cornerstones upon which we built our reputation and our success. Jzanus’s accomplishments are the result of our New York best practice experience, our proprietary technology platform and most importantly the Jzanus team.
Our people are senior level professionals with extensive provider, payer, clinical, HIM and home care experience who are very aware of the business challenges that face you daily. Jzanus Consulting specializes in providing HIM coding validation, clinical documentation improvement, and cost outlier recovery to hospitals and hospital-owned physician organizations. We have earned the trust of our customers by utilizing only the most qualified HIM consultants.
By ensuring compliance and coding accuracy for optimal reimbursements, we provide significant value to our customers.
Sourced from a public job board.
How this role fits you
Worth asking
The posting doesn’t answer these. Good ones to ask a recruiter or in the interview.
- Can you walk me through differentials?
- What should I expect for shifts, weekly hours, holiday, call, and rotation?
- What orientation, preceptor time, and ongoing unit support are included?
- How are patient load, floating, and staffing support handled day to day?
