Remote Nurse Auditor - Medical Bill Review

Summary

Join our team at Rising Medical Solutions as a part-time Nurse Auditor (20-24 hours/week) to maximize client savings by reviewing medical bills from a nurse perspective. In this role, you'll audit medical and billing records, verify charges, initiate contacts with clients and providers, and negotiate bills.

Responsibilities

• 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
• Consistently meet productivity and turn-around time requirements
• Adhere to quality standards, state billing guidelines, HIPAA rules, and confidentiality of all information, policies, and procedures
• Negotiate bills and conduct re-evaluation reviews as required
• Conduct re-evaluation reviews as required
• Serve as a resource person to co-workers
• Demonstrate sensitivity to culturally diverse people and situations
• Continually improve job skills and maintain in-depth knowledge of all company products and services as well as customer issues and needs through ongoing training and self-directed research
• Follow appropriate report formats and documentation guidelines
• Perform other administrative or corporate duties upon request