Nurse Auditor

Role Overview

• Functions as Hospital Liaison with Third Party billing and auditing firms for all audits for LVHN locations
• Reviews all audits in LVHN audit software and writes appeals for charge and line item audit denials
• Communicates audit results and develops action plan to reduce incidence of denials for LVHN
• Provides explanation of hospital charges to inquiring patients
• Participates in revenue recovery/revenue enhancement through verification of correct charging procedures in EMR
• Provides education to hospital departments to facilitate correct charges on all claims
• Works with Physician Advisors on appeals to payors/third party vendor and documents follow up in LVHN audit software and EMR
• Collaborates with management team for audit appeal disputes or issues
• Creates audit appeal letters based on charging practices or medical necessity documentation
• Coordinates audit appeals that need a physician’s input with the payor
• Identifies areas of incorrect charging practice and provides action plan to correct

Requirements

• Specialized Diploma in nursing
• 10 years clinical experience
• Ability to read medical charts and identify deficiencies in documentation content
• Ability to adapt to ongoing changes within the health insurance industry
• Knowledge of medical policy per payor guidelines
• Knowledge of Auth/Cert and utilization review
• Knowledge of Epic workflows
• Intermediate knowledge of Excel and MS Word
• RN
• Licensed Registered Nurse_PA
• State of Pennsylvania Upon Hire

Benefits

• Health insurance
• Paid time off
• Flexible work arrangements
• Professional development opportunities