Audit medical and billing records to determine if services provided are reasonable, appropriate and necessary.
Clinically identify and evaluate any charges not related to the occurrence.
Verify that charges are in accordance with the services ordered and authorized.
Initiate appropriate contacts with clients and medical providers as appropriate and necessary.
Negotiate bills and conduct re-evaluation reviews as required
All while maintaining a human touch, demonstrating sensitivity to culturally-diverse people and situations.

RN (or LPN) with active professional license or equivalent within states of operation
CPC and/or CPC-H certification(s) strongly desired
Specialized training in hospital coding, ortho, neuro, rehab, or ER procedures
3-5 years of clinical experience in acute care, surgery and/or orthopedic
Workers’ Compensation medical bill review experience a major plus
Understanding of CPT and ICD-10 codes and Medicare guidelines
Ability to apply knowledge to state fee schedules
A customer service orientation, including strong communication skills
Experience in any deposition or litigation cases a plus

Competitive benefits package, including health insurance, 401(k) with company match, paid time off, paid holidays, and more.
Flexible hybrid schedule with in-office days reserved for training and collaborative meetings
Employment within a firm committed to core values, staff development, emerging technology, private ownership, and controlled growth/reinvestment in the future
we frequently promote from within!
Opportunity to make a difference in reducing health care costs and increasing the value of health care to individuals and their employers.
A relaxed, yet upbeat work environment
And for those in the office: casual dress code with unlimited coffee!

Nurse Auditor - Medical Bill Review

Key skills