Equian is looking for a Hospital Bill Audit - Nurse Auditor in the Atlanta/Athens, GA area. The RNAuditor monitors new case assignments, schedules and performs hospital bill audits within a specified time frame. Reviews records within each client’s specification and ensures that charges are appropriate. Identifies issues of quality of care, length of stay and appropriateness of care and documents in Equian’s audit system. Works closely with audit managers.
Auditor will receive training on Equian’s auditing system to produce client specific forms required for sign off at the conclusion of the audit process. Throughout training the employee must pass training benchmarks with minimum 95% accuracy.
KEY RESPONSIBILITIES AND DUTIES:
Performs all necessary duties related to Provider Bill Audit including:
- Audits may scheduled for or the auditor must schedule all new cases within a 7 days of receiving assignment
- Maintains current status of claims
- Maintains communication with audit managers regarding problems with scheduling, access issues, contract issues
- Confirms bill amount at time of scheduling and 5 days prior to audit
- Assures quality of prepped bill for accuracy
- Prior to audit, reviews prep detail for audit savings
- Reviews medical record and other hospital documents to verify that orders and documentation are present to justify charges billed to payer
- Reviews the medical records within each client’s specification and ensures that charges are generated in the most cost-effective way for the client
- Identifies issues of quality of care, length of stay, and appropriateness of care and initiates the payer referral for all issues
- Performs quality check on all completed work for thoroughness and accuracy
- Electronically submits completed work to the office in a timely manner
- Maintains caseload as set by Equian
- Negotiates discrepancies on behalf of Equian and Client
- Attends all training and inservices mandated by Equian
JOB EVALUATION FACTORS:
IP Skills: Competency in nonverbal, oral and written communications particularly in the area of conflict resolution; ability to identify, define and explain day-to-day problems and solutions.
Education: Baccalaureate degree with concentration in study specific to job assignment. Registered Nurse.
Experience: Five or more years job-related work experience. At least 3 years acute care experience in a hospital setting.
Knowledge: Knowledge of an extensive body of procedures and operations requiring specialized knowledge developed from specialized training and extensive experience. Independent judgement is a critical element of jobs at this level.
Innovation: Ability to adapt or enhance quality in existing methods to reach same results; Problems and issues may be only vaguely defined and require consideration of other job areas.
Level of Responsibility: Direct, but minimal supervised, impact on quality and efficiency of services or operation of company or revenues/expenses. Permitted to make decisions on moderately complex problems/issues.
Mobility as required to move about the office or medical facility and ability to travel unassisted and alone.
Hearing as required to communicate via telephone and in person both internally and externally.
Ability to sit for prolonged periods of time.