Nurse Auditor  Nurse Auditor Richardson Texas – IMMEDIATE OPENING – Contract-to-Hire

Location: Richardson, TX
Job Type: Temp/Contract to Direct
Ref. Code:
Compensation: 34.00 USD/HOUR
Start Date: 00/00/0000
End Date: 00/00/0000
Hours: Full Time
Req’d Years of Experience: 3 -5
Req’d Education: RN
Travel: Yes
Relocation: No
Commute: Nurse Auditor Richardson Texas

Nurse Auditor Richardson Texas
Nurse Auditor Richardson Texas


Nurse Auditor Richardson Texas Company Summary

Job Description:
Nurse Auditor Richardson Texas– IMMEDIATE OPENING – Contract-to-Hire position
Department: Central Billing Office (CBO) – Richardson, TX

Job Purpose for Nurse Auditor:

To improve the overall health and wellness of the community through structured medical record review audits using evidence based medicine, educating physicians and their staff of the results of audits, and identifying processes for improvement. The quality audits are integral to health care reform and new payment methodologies. The Nurse Auditor assists in the development and ongoing implementation of the physician office quality review initiatives using HEDIS, CMS and other national evidence based medicine measures.

The individual must be able to respectfully and effectively educate and coach physicians, mid-level practitioners, nurses and medical assistants on documentation findings following a medical record audit, and suggest “best practice” methodologies to optimize the provision of evidence based medicine to improve the health of the community.

Responsibilities include conducting the medical record audits, scoring and graphically displaying results, educating physicians and their staff, and assisting in the development of action plans for the organization to improve and enhance health in the community. The nurse auditor serves as a liaison for managed care issues within the physician organization. Works cooperatively within the team, including other nurse auditors, and participates in the quality committee.

Summary of Nurse Auditor Richardson Texas responsibilities:

Audit Accountability:

- Insurance Defense Audits
- Patient request charge audits
- Observation hour – selective review
- SWTA Pre-audit – need to develop process – South West Transplant (looking at organ donor’s chart to make sure charges are appropriate
- Other audits as needed / focus charge capture audits (i.e. OIG)
- Charge reconciliation on all audits
- Report Management (Rejections – Charge entry rejections – need to review charge rejections to make sure the departments are completing them timely)
- CGI/Meditech edits (IV therapy, incidentals, etc) for all locations
- Provide ICD-9 codes to insurance verification/financial counselor – only on procedures that MRMC have not done before or have not done in a while, so they would want the Nurse Auditor to review to obtain a correct ICD-9 code

RAC/Billing CBO Accountability:

- Missing observation hours
- Receive and communicate to CBO RAC ADR, findings, reimbursement
- Notify Manager of ADR request/documentation submission
- Review and formulate appeal for auto and medical necessity denials

Denials Accountability:

- Medical necessity appeals for MRMC. Medical Necessity located on the “Q” Drive
- Response coordination with doctors

Multiple Department Interaction Accountability:

- Point-of-Contact for: Late charge entry/correction, questions on charging, account combinations, account hold for pending charges
- Account hold notifications have to be forwarded to CBO Billing / Payment Analyst CBO
- Point-of-Contact for clinical and non-clinical staff billing/charge compliance issues
- Review focus audits results with departments and develop process improvement plan for identified errors
- Conduct department education on charging (work with Finance Department)
- Work with Finance to resolve coding/charging discrepancies on outpatient
- Serve as coding/charging reference to patient access/insurance verification

Required Qualifications
Qualifications for Nurse Auditor Richardson Texas:

- Education: Graduate from an accredited school of Nursing
- Licenses and/or Certifications (Required and Preferred): Licensure as a Registered Nurse in the State of Texas
- Related Work Experience and Other Skills:
- Nurse Auditor background
- Board based nursing knowledge
- Ability to write letters of medical necessity
- Ability to work efficiently with multiple departments (Central Billing Office, Finance, RAC, Denials and other departments when appropriate)
- High degree of self-confidence and ability to work independently and within a team of professionals
- Ability to use basic mathematical formulas (means, percentages, medians) using Excel
- Experience working in a physician’s office, hospital quality review department, or managed care organization is preferable
- Maintains a professional demeanor in all situations
- Must be highly organized and able to compile and analyze data
- Must be able to multitask, self-manage a busy schedule, and adhere to timelines
- Thorough knowledge of Microsoft Office – Word, Excel and Outlook
- Typing and broad based computer skills required
- Work Experience: 3 years of relevant auditing experience or 5 years of board based nursing experience

Required Skills
Central Billing
Hospital experience
Managed Care
Medical Billing
Medical Coding
Microsoft (MS) Office
Nurse Auditor
Physician office
Registered Nurse (RN)

Apply: Nurse Auditor Richardson Texas

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