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Nurse Auditor


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Nurse Auditor

POSITION SUMMARY: The Hospital Nurse Auditor- RN/LPN coordinates and performs audits of patient accounts in accordance with hospital, state and federal guidelines. Combines accounts per Medicare billing policies. The incumbent is responsible for performing chart audits to determine correctness of the charges and codes as it relates to the services rendered based on medical documentation. This position also works inter and intra departmentally to appeal medical necessity for Medicare and Managed Care payers. The incumbent will also work closely with the Scheduling Department in verifying appropriate documentation is in the hospital medical records for elective visits requiring meeting medical necessity criteria. POSITION EXPECTATIONS & RESPONSIBILITIES: Should have the ability to read, analyze and interpret general business periodicals, professional journals, technical procedures or governmental regulations. Review charts and make corrections on accounts when the room charges do not agree with type of service or the quantity does not agree with the dates of service. Review AHCA error report, correct and report findings to Decision Support. Identify CDM discrepancies and return to director for corrections. Review CMS denials, combine credit and charge accounts, identify documentation discrepancies, and perform compliance audits. Review proper revenue code and CPT code assignment. Exhibit adaptability, flexibility, self- control and maturity in work and behavior. Expected to effectively present information and respond to questions from groups of managers, clients' customers and the general public. Expected to perform and coordinate audits for patients and third party payors to verify the accuracy and appropriateness of charges within 10 to 15 working days. Verify that all Medicare outpatient self-administered drug reversals are done correctly on each account on a daily basis (Pharmacy). Will be responsible for the Medicare 72-hour readmit and the overlapping dates of service bundling of accounts on a daily basis (DPW in place). Review random bills for correctness of the charges and verify the correctness of late charges/credits on a weekly basis. Minimum Qualifications: Minimum two years related experience (previous hospital charge audit experience strongly preferred). Current Florida Licensure as Registered Nurse or LPN. Incumbent may be required to perform emergency duty before, during and/or beyond normal work hours or days in the event of an emergency, crisis situation or disaster (man-made or natural) including evacuation sites. The person in this position will work in a smoke-free location, and is expected to adhere to all smoking restrictions. In the spirit of wellness for both our employees and patients, Boca Raton Regional Hospital has instituted a mandatory influenza prevention vaccination program. Current employees must receive the influenza prevention vaccination free of charge during the recognized flu season. As a condition of employment, new hires will be required to comply with all program rules. This is a mandatory program with the exception of documented medical or religious reasons for not receiving the vaccine. For further information on this progressive program, please contact Boca Raton Regional Hospital's Human Resources Department at .

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