Hospital Bill Audit Nurse I

CERIS, a division of CorVel Corporation, a certified Great Place to Work® Company, offers incremental value, experience, and a sincere dedication to our valued partners. Through our clinical expertise and cost containment solutions, we are committed to accuracy and transparency in healthcare payments. We are a stable and growing company with a strong, supportive culture along with plenty of career advancement opportunities. We embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

The Hospital Bill Audit Nurse conducts hospital bill charge audits by reviewing medical records to verify that services were provided and charges are appropriate based on medical documentation and industry guidelines. The types of audits performed could include, but are not limited to inpatient, outpatient, NICU, and hospice. Charge audits identify overcharges, undercharges, and unbundled items per payor contract and industry standards. This candidate will be responsible for independent scheduling requiring flexibility and travel to provider location. This is a remote position.

Onsite scheduling and travel – acknowledge work that is assigned, maintain timely communication with Audit Coordinator, schedule and complete audits in an efficient and timely manner Travel onsite as needed to perform audits Review medical records to verify services were provided and charges are accurate – Identify overcharges, undercharges, unbundled items, errors, duplicates, and routine services, equipment and supplies Identify discrepancies if they exist and document the findings using standard documentation guidelines applicable to the position Understand audit and data information to make decisions with accurate results Document all unsupported charges identified in the course of an audit for each case Report any problems in the audit process to the manager and/or supervisor for resolution Comply with all HIPAA and other regulations regarding the confidentiality of patient information Comply with all provider and internal policies and guidelines Must represent CorVel/CERIS in a professional and knowledgeable manner Additional duties/responsibilities as assigned by manager and/or supervisor