Itemization Review Nurse

We are seeking an Itemization Review Nurse I to support payment integrity efforts through detailed review of hospital itemized bills. This role focuses on validating charge-level accuracy, identifying billing discrepancies, and ensuring services billed are supported by clinical documentation and applicable guidelines. This position is well-suited for Registered Nurses who enjoy analytical work, have strong attention to detail, and are interested in transitioning into non-bedside, audit-focused roles.

Review hospital itemized bills for accuracy, completeness, and compliance Validate individual charges against medical records and clinical documentation Identify billing discrepancies such as duplicate charges, unbundling, incorrect units, and unsupported services Apply CMS regulations, payer billing guidelines, and internal audit standards Document audit findings clearly and consistently within internal audit systems Meet established quality, productivity, and turnaround time benchmarks Maintain compliance with internal policies and confidentiality requirements