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  • Portland, OR

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Registered Nurse Auditor

The Judge Group • Portland, OR

Posted 23 days ago

Job Snapshot

Experience - At least 3 year(s)
Degree - 4 Year Degree
Other Great Industries
Finance, Nurse, Accounting, Health Care

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Job Description

Judge Healthcare is currently seeking a Registered Nurse Auditor in Portland, OR!

Utilize clinical expertise to plan, coordinate, conduct and report on post service audits to ensure accuracy of billed charges. 

This job will have the following responsibilities:
  • Conducts coding audits, quality assurance assessments of claims, reviews statistical samples and analyzes for risk.
  • Applies nursing expertise to ensure compliance with medical policy, medical necessity guidelines and accepted standards of care.
  • Conducts audits to determine if claims adhere to specific provider and hospital contracts.
  • Ensures that medical claims, medical records and other documentation essential to proper billing is in compliance with federal regulation, company policies and industry standards.
  • Develops written audit findings with respect to contractual compliance, recommendations for improved contracts, and other matters identified during the audit.
  • Writes audit reports, as applicable. Assesses and communicates the level of risk associated with the audit issues identified in the report.
  • Conducts surveys of complex audit areas to define the scope and objectives of audits.
  • Assists in the development of overall audit plans, including comprehensive audit programs that identify specific procedures and tests designed to achieve the audit objectives.

Qualifications & Requirements:
  • Current unrestricted license as an Registered Nurse within either OR, WA, ID or UT
  • Nurse Auditor I would have a Bachelor's Degree in Healthcare and 3 years of experience in a clinical setting, health insurance, coding/claims review, case management or equivalent combination of education and experience.

Job ID: 570670
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