Auditor 1 - HBA Nurse -Inpatient Program Contractor
Overview
SCIO Health Analytics/ an EXL Company is seeking an experienced and self-motivated Nurse Auditor - HBA, Independent Contractor for a remote, Home Office opportunity.
The Nurse Auditor conducts hospital bill charge audits by reviewing medical records to verify services were provided and charges are appropriate. Charge audits identify overcharges, undercharges and unbundled items per carrier contract and industry standards. They will also be responsible for independent scheduling requiring flexibility and possible travel to provider location. Requires strong clinical experience and technical skills. Three years experience with managed care organization, TPA, government agency preferred.
Responsibilities
Key Duties and Responsibilities:
- Review medical records to verify services were provided and charges are accurate - Identify overcharges, undercharges and unbundled items.
- Identify if a discrepancy exists and document the findings using standard documentation guidelines applicable to the program.
- Onsite Travel – Maintain timely communication with Audit Coordinator regarding scheduling, completion and submission of audits. Abide by the SCIO Travel policy while making travel arrangements for onsites.
- Scheduling onsites – Acknowledge work that’s assigned, call providers and schedule date and time to perform onsite, travel onsite and perform audits.
- Report any problems in the audit process to Manager for resolution.
- Comply with HIPAA and other regulations regarding the confidentiality of patient information.
- Will perform other duties as assigned.
Qualifications
Knowledge and Skills:
- Acute care experience
Qualifications:
- RN with current active license
- Minimum of 5 years diverse clinical experience
- Previous auditing experience internal or external
- CPC, CCS or CMAS desired.