Nurse Auditor

NURSE AUDITOR

Position No.: 125-30127

Salary Range: $4,857 to $6,938 per month. For full salary package, click here: Total Rewards Calculator

Closing Date: February 21, 2024

Status: Full-Time with State Benefit Package

Recruitment: Internal/External

Location: Medicaid Fraud Control Unit, Bismarck, ND

Selecting Supervisor: Marina Spahr, Director, Medicaid Fraud Control Unit

Summary of Work

The Nurse Auditor will assist in Medicaid provider fraud investigations by:

1. Reviewing provider and recipient medical records for billing fraud or abuse/neglect.

2. Procuring, analyzing and interpreting computerized data, financial records, medical records, investigative records, legal documents, federal and state laws, regulations, policies and other material in the pursuit of evidence of fraud and abuse or neglect.

3. Reviewing complaints filed with NDMFCU to identify cases of fraud and/or abuse and neglect requiring further investigation.

4. Making determinations of medical necessity.

5. Making determinations as to whether services were provided and properly documented.

6. Making determinations as to whether proper diagnostic and procedure codes were used in submitting claims to the ND DHS Medicaid program.

7. Performing detailed reviews of inpatient or outpatient medical accounts, comparing the medical record documentation with the itemized bill for Medicaid.

8. Coordinating and reporting outcomes regarding charge errors and losses for ND Medicaid.

9. Participating as a member of an interdisciplinary team in healthcare fraud investigations and providing support to members of other disciplines in such investigations.

10. Participating in interviews of subjects and witnesses.

11. Preparing written summaries of findings and opinions.

12. Testifying as a witness in trial court proceedings.

13. Maintaining a comprehensive understanding of current policies and procedures of the ND Medicaid Program.

In addition to the monthly salary, this position includes fully paid health insurance for employee and family, the option to participate in employee-paid dental and vision for employee and family, participation in the state NDPERS defined benefit retirement plan as well as the option to participate in the 457 deferred compensation plan, the option to contribute to a medical spending account, and earning annual and sick leave.

Employees in this position are eligible for the Public Service Loan Forgiveness (PSLF) program.

Minimum Qualifications

1. Current RN license.

2. Graduation from an accredited four-year college or university with major course work in nursing or related fields.

3. Demonstrated experience in the analysis of Medicaid claims.

4. Ability to understand and interpret medical records, hospital bills, and the charge master.

5. Must be team-oriented with strong interpersonal skills.

6. Must have ability to communicate orally and in written form.

7. Ability to establish and maintain effective, harmonious working relationships with co-workers and supervisors.

8. Ability to maintain a high degree of confidentiality.

9. Display interpersonal skills in dealing with customers and co-workers, utilize appropriate telephone etiquette, demonstrate appropriate written and verbal communication skills, and demonstrate ability to perform standard office tasks and operate standard office equipment.

10. Successful completion of the interview process, reference checks, and standard background and criminal record checks to determine knowledge, skills, and abilities to perform Nurse Auditor tasks.

:

1. Prior nursing experience in a clinical, hospital, or long-term care setting.

2. Advanced Practice Nursing Degree.

3. Experience with abuse, neglect, and exploitation investigations.

4. 5 years of experience as an RN.

5. Experience with PCs, word processing, spreadsheet, graphics, and database software applications.

6. Previous auditing experience.

7. Strong quantitative, analytical, and organization skills.

8. Proficient in chart review, clinical record information systems, and coding methodologies.

TeamND

"Far and away the best prize life offers is the chance to work hard at work worth doing." - Theodore Roosevelt

More than 7,500 talented, hard-working people across sixty-three agencies have come together as Team North Dakota. At Team ND, we are driven to succeed through gratitude, humility, curiosity and courage. Our purpose is to empower people, improve lives, and inspire success. Join us in being legendary.

Total Rewards: The State of North Dakota is committed to providing team members with a strong and competitive rewards package that support you, your health and your family.

Considering a new position on Team ND? How does your current position stack up? Use our Total Rewards Calculator to estimate.

Application Procedures

Applicants are screened based on qualifications, successful completion of the interview process and a background and criminal investigation. Applicants must be currently authorized to work in the United States on a full-time basis. The Office of Attorney General does not provide sponsorships.

Application package must be received by 11:59 PM on the closing date listed on the opening.

TO BE CONSIDERED FOR THIS POSITION APPLICATIONS MUST BE SUBMITTED ONLINE AT: www.nd.gov/careers

Documents to be submitted:

• Resume
• Cover letter with a summary that clearly explains how the applicant's work experience is related to the summary of work and minimum/preferred qualifications
• 3 Professional References
• College Transcripts (copies or unofficial versions are acceptable)

Anyone needing assistance or accommodations during any part of the application or interview process please contact Ashley, Office of Attorney General: phone: (701) 328-1256 or TTY: 1-800-366-6888.

• Learn more about Office of Attorney General at: https://attorneygeneral.nd.gov/
• Learn more about Employment Benefits at: https://www.nd.gov/omb/public/careers/team-nd-benefits
• Visit North Dakota State government: http://www.nd.gov

Equal Employment Opportunity

The State of North Dakota and this hiring agency do not discriminate on the basis of race, color, national origin, sex, genetics, religion, age or disability in employment or the provisions of services and complies with the provisions of the North Dakota Human Rights Act.

As an employer, the State of North Dakota prohibits smoking in all places of state employment in accordance with N.D.C.C. § 23-12-10.

Job Type: Full-time

Pay: $4,857.00 - $6,938.00 per month

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance

Schedule:

• Day shift
• Monday to Friday

Ability to Relocate:

• Bismarck, ND: Relocate before starting work (Required)

Work Location: In person