The Clinical Nurse Auditor is responsible for auditing abstracted accounts and charges to ensure compliance with all State and Federal guidelines and regulations, appeals of clinical issues on claims, assisting with the review, analysis and resolution of denied, underpaid and audited claims, coordinating efforts related to payer audits and providing feedback to hospital charging departments on documentation , charges and charge master coding.
Minimum Education: BS degree in nursing with three years of clinical experience as a Registered Nurse, including at least two years of experience performing chart audits. Diploma or AD nurse will be considered with at least five years of experience in auditing charts or similar functions in an acute care setting.
Licences/Certification: Must possess a valid license as a Registered Nurse in North Carolina. Certification as a nurse auditor is preferred.
Skills/Knowledge: Must be able to communicate clearly and concisely, both orally and in writing; effectively present information to groups and individuals. Must establish and maintain cooperative working relationships with physicians, nurses, administrative team, auditors and other health care personnel. Must provide excellent public relations and courteous customer service. General familiarity of DRG and CPT coding systems is helpful.
Required Degrees And Majors:
Bachelors in Nursing
Required Licenses And Certificates: