RN/LVN - OR Nurse Auditor - Part Time
Titus Regional Medical Center
Part-time
On-site
Mount Pleasant, Texas, United States
Auditing, Regulatory, Quality, and Compliance
Job: Nurse Auditor
Classification: Hourly/Non-Exempt
Job Category: 2 Professionals
Position Summary
The Nurse Auditor is responsible for reviewing medical records to determine whether documentation substantiates the medical necessity, quality of care, utilization and coding of insurance claims. The Nurse Auditor ensures that data collection for reporting purposes from various departments is within charging practices and departmental policies. Duties include reviewing remittance advices for denials and the appeal process, and finalizing department audit summaries. The Nurse Auditor ensures optimal billing methods that meet with billing compliance standards.
Essential Functions
-Ensures that correct charges are entered for patient care services.
-Communicates estimates of charges for services, corrects problems with billing.
-Reviews charts for correctness and completeness.
-Coordinates with Finance on perioperative services charged.
-Assists in training staff to verify and explain charges.
-Provides feedback and education to staff.
-Audits medical records to ensure compliance; notifies appropriate personnel to make any needed corrections.
-Provides feedback concerning charge errors and complaints.
-Acts as a liaison concerning billing charges.
-Able to communicate effectively with all level of management.
-Reports to and departs from work on time and as scheduled.
-May function as a RN Circulator when required.
-Performs other duties as necessary.
-Must be able to deal with stress while maintaining composure.
-Follows and adheres to TRMC vaccine policy(s) mandated by the Centers for Medicare & Medicaid Services (CMS).
Work Experience
-2 years of experience performing audits to ensure maximum achievable reimbursement, preferred.
Education
-LVN or Registered Nurse currently licensed to practice in the State of Texas required.
-Knowledge of CPT, ICD9-CM, HCPCS, or other coding structures preferred.
-BLS (Basic Life Support) required within 30 days of hire date.
-ACLS (Advanced Cardiovascular Life Support) required within 90 days of hire date.
-PALS (Pediatric Advanced Life Support) required within 90 Days of hire date.
Physical Demands and Work Environment
Lifting/Carrying Pushing/Pulling
Lbs. % Time Lbs. % Time
1-10 34-66 1-10 34-66
11-20 0-33 11-20 0-33
21-50 0-33 21-50 0-33
51-75 0-33 51-75 0-33
76-100 None 76-100 None
Movement % Time
Bend/Stoop/Twist 0-33
Crouch/Squat 0-33
Kneel/Crawl 0-33
Reach above Shoulder 0-33
Reach below Shoulder 0-33
Repetitive Arm 34-66
Repetitive Hand 34-66
Grasping 34-66
Squeezing 34-66
Climb Stairs 0-33
Walking Uneven 0-33
Walking Even 34-66
Environment % Time
Indoors 67-100
Outdoors 0-33
Extreme Heat None
Dusty None
Excessive Noise 34-66
Classification: Hourly/Non-Exempt
Job Category: 2 Professionals
Position Summary
The Nurse Auditor is responsible for reviewing medical records to determine whether documentation substantiates the medical necessity, quality of care, utilization and coding of insurance claims. The Nurse Auditor ensures that data collection for reporting purposes from various departments is within charging practices and departmental policies. Duties include reviewing remittance advices for denials and the appeal process, and finalizing department audit summaries. The Nurse Auditor ensures optimal billing methods that meet with billing compliance standards.
Essential Functions
-Ensures that correct charges are entered for patient care services.
-Communicates estimates of charges for services, corrects problems with billing.
-Reviews charts for correctness and completeness.
-Coordinates with Finance on perioperative services charged.
-Assists in training staff to verify and explain charges.
-Provides feedback and education to staff.
-Audits medical records to ensure compliance; notifies appropriate personnel to make any needed corrections.
-Provides feedback concerning charge errors and complaints.
-Acts as a liaison concerning billing charges.
-Able to communicate effectively with all level of management.
-Reports to and departs from work on time and as scheduled.
-May function as a RN Circulator when required.
-Performs other duties as necessary.
-Must be able to deal with stress while maintaining composure.
-Follows and adheres to TRMC vaccine policy(s) mandated by the Centers for Medicare & Medicaid Services (CMS).
Work Experience
-2 years of experience performing audits to ensure maximum achievable reimbursement, preferred.
Education
-LVN or Registered Nurse currently licensed to practice in the State of Texas required.
-Knowledge of CPT, ICD9-CM, HCPCS, or other coding structures preferred.
-BLS (Basic Life Support) required within 30 days of hire date.
-ACLS (Advanced Cardiovascular Life Support) required within 90 days of hire date.
-PALS (Pediatric Advanced Life Support) required within 90 Days of hire date.
Physical Demands and Work Environment
Lifting/Carrying Pushing/Pulling
Lbs. % Time Lbs. % Time
1-10 34-66 1-10 34-66
11-20 0-33 11-20 0-33
21-50 0-33 21-50 0-33
51-75 0-33 51-75 0-33
76-100 None 76-100 None
Movement % Time
Bend/Stoop/Twist 0-33
Crouch/Squat 0-33
Kneel/Crawl 0-33
Reach above Shoulder 0-33
Reach below Shoulder 0-33
Repetitive Arm 34-66
Repetitive Hand 34-66
Grasping 34-66
Squeezing 34-66
Climb Stairs 0-33
Walking Uneven 0-33
Walking Even 34-66
Environment % Time
Indoors 67-100
Outdoors 0-33
Extreme Heat None
Dusty None
Excessive Noise 34-66
Equipment % Time
Motor Vehicles None
Foot Pedals None
Extreme Heat None
Dusty None
Excessive Noise 0-33
Work near % Time
Machinery 34-66
Electricity 34-66
Sharps 34-66
Chemicals 34-66
Fumes 34-66
Heights None
Vision
Depth Perception Required
< 20" Required
Color Not Required
Peripheral Required
Endurance Hours at Once Total in 12HR
Sit 1 2
Stand 4 8
Walk 1 2