Nurse Auditor, RN/ LPN
Are you an experienced Registered Nurse or LPN looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered yes" to any of these questions this is the position for you!
Coordinates and performs all chart audit activities(denials and turnaround times) of Provider Groups who support plan members and the care they receive,providingdocumentation to support UM, charges and accuracy in billing. Audits patient and insurance request audits to ensure appropriate referrals and utilization of care; coordinates the correcting of discrepancies found in audits/ approvals/ denialswith departments and provide training to departments on charge issues found during audits.
- They will be reviewing medical records and determining if additional Medical Director review is needed or if authorization can be granted if medically necessary.
- The requests are from providers who have seen plan members and they either have not gotten paid, got paid a difference in expectation or member LOC was higher than authd andthe reviewer and determines next steps to uphold or overturn.
- Reviews medical records for accuracy and billing compliance as support for billers and coders. medical necessity and where appropriate work through the Provider Group'sfinancial departments to identify physician and clinic practices that require improved documentation.
- Develops corrective action plans when UM or billing deficiencies are identified, and documents follow-up to completion.
- Ensures Provider Groups compliance with reporting requirements by tracking the receipt and completeness of reports.
- Develops corrective action plans when compliance issues are identified, and document follow-up to completion.
- RN/ LPN
- MCObackground- Must Have
- Previous experience withPhysician/ Provider Group Billing
- Prior Authorization experience
- Must be familiar with physician referrals, medical decision-making, evaluating turn-around times, working in a clinical environment, compliance practices
- Provider Appeals/ Denials/ Billing
- Strong MS/ Excelapplications skills
Hours for this Position:
M-F: 8a 5p. NO nights, weekends or travel is required
Advantages of this Opportunity:
Competitive salary, negotiable based on relevant experience!!!
Benefits offered, Medical, Dental, and Vision!!!
Fun and positive work environment
Career advancement opportunitiesCompany Description
HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!