Nurse Auditor - Medical Bill Review

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Conduct audits of medical and billing records to assess the reasonableness, appropriateness, and necessity of services rendered.

• Clinically identify and assess any charges that are unrelated to the incident.

• Ensure that charges correspond with the services that have been ordered and authorized.

• Establish necessary and appropriate communication with clients and medical providers.

• Negotiate bills and perform re-evaluation reviews as needed.

• All while maintaining a compassionate approach, showing sensitivity towards culturally diverse individuals and situations.

⛳️ Requirements

• Active RN (or LPN) professional license or an equivalent qualification in the states of operation.

• CPC and/or CPC-H certification(s) are highly preferred.

• Specialized training in hospital coding, orthopedics, neurology, rehabilitation, or emergency room procedures.

• 3-5 years of clinical experience in acute care, surgery, and/or orthopedics.

• Experience in Workers’ Compensation medical bill reviews is a significant advantage.

• Familiarity with CPT and ICD-10 codes as well as Medicare guidelines.

• Ability to apply knowledge of state fee schedules.

• Strong customer service orientation, with excellent communication skills.

• Experience with deposition or litigation cases is a plus.

🏝️ Benefits

• Competitive benefits package, which includes health insurance, a 401(k) with company match, paid time off, paid holidays, and more.

• Flexible hybrid work schedule with designated in-office days for training and team meetings.

• Employment in a firm that values core principles, staff development, cutting-edge technology, private ownership, and intentional growth/reinvestment – we often promote from within!

• Opportunity to contribute to reducing healthcare costs and enhancing the value of healthcare for individuals and their employers.

• A relaxed, yet vibrant work atmosphere.

• For those working in the office: a casual dress code and unlimited coffee!