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Chart Audit Review Nurse

Chart Audit Review Nurse

Job Description

Position Summary:  Full or Part-time in Northern KY or the West Chester OH area.

Primarily responsible for thorough review of medical records and other medical documentation to determine appropriate billable services for hospital or to determine stop loss for applicable managed care contracts.

Essential Duties and Responsibilities:

  • Build strong, lasting relationships with clients, payors and BLS personnel
  • Analyze medical records or other medical documentation to validate services, tests, supplies and drugs performed and compare to hospital itemized billing records
  • Ability to identify and interpret medical, radiological, laboratory or other tests and procedures as well as pharmaceutical drugs
  • Ability to review and understand managed care contracts, hospital billing statements/bills and insurance denials
  • Document and maintain chart audit results
  • Communicate with hospital and payor personnel concerning all issues relating to chart or stop loss audit both in an informal manner through daily contact and formal manner through scheduled exit audits
  • Maintain confidentiality of information in compliance with company policy and HIPAA
  • Exercise independent judgment as issues arise regarding specific assigned client’s medical audits and reviews
  • Maintain regular contact with necessary parties including payors, clients, managers and other BLS personnel
  • Attend client, department and company meetings
  • Comply with federal and state laws, company and department policies and procedures

Job Requirements

Essential Skills and Experience:

  • College degree or diploma from school of nursing - must be RN
  • Clinical nursing experience working in hospital environment, preferably in ER, ICU, Med-Surg or Transplant Unit
  • Moderate computer proficiency including working knowledge of MS Excel, Word and Outlook
  • Excellent interpersonal and communication skills
  • Mathematical skills:  ability to calculate rates using addition, subtraction, multiplication and division
  • Ability to read and interpret an extensive variety of documents such as contracts, claims, instructions, policies and procedures in written (in English) and diagram form
  • Ability to present written routine correspondence (in English)
  • Ability to define problems, collect data, establish facts and draw valid conclusions
  • Strong customer service orientation
  • Excellent interpersonal and communication skills
  • Strong team player
  • Commitment to company values

Job Snapshot

Other Pay Quarterly Bonus Incentive tracking after six months
Employment Type Full-Time
Job Type Health Care, Nurse, Customer Service
Education 4 Year Degree
Experience Not Specified
Manages Others Not Specified
Industry Healthcare - Health Services, Managed Care, Consulting
Required Travel Not Specified
Job ID CARN-Corp
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Chart Audit Review Nurse

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