Nurse Auditor

Interprets and analyzes the patient's medical record to assure the patient's bill accurately reflects goods, supplies and services received. Responsible for reviewing all Medicare and other payers' outpatient bills to identify if specific services are diagnostic, therapeutic, or radiologic, to identify self-administered drugs, and to determine other specific regulation requirements. Works closely with patients, insurance companies, hospital departments, physician practices, and outside agency auditors to support hospital protocol, resolve/negotiate questioned charges, work with Revenue Integrity Liaisons and Reimbursement Specialists to write payer appeals when clinical expertise is needed and provider patient estimates.
EDUCATION AND EXPERIENCE:
Current Registered Nurse licensure from the State of Nebraska or approved compact state of residence as defined by the Nebraska Nurse Practice Act. Minimum of two (2) years clinical experience as a Registered Nurse required. Varied critical care and medical surgical experience preferred. Auditing experience preferred. Working knowledge of hospital charging, billing, and payer regulations.