RN/LPN, Nurse Auditor

Responsibilities

• The Nurse Auditor I performs charge audits and potential client assessments as assigned by management.
• This role is responsible for timely resolution of all incorrect and/or missing charges to prevent revenue loss and to ensure compliance requirements are met.
• Identifies opportunities for any additional documentation needs to support charges captured.
• Conducts regular audits to look for opportunities of missing revenue and reports to management.
• Fulfill audits requests by reviewing clinical documentation, identify trends for missing and/or incorrect charges and report on findings.
• Applies clinical knowledge to educate stakeholders on standards for documentation and charge capture practices and to look for opportunities of improvement based on audit outcomes.
• Responsible for reviewing Injection & Infusion work queues in Epic.
• Resolve prebill and post bill missing and error charges identified by Opera Solutions software to prevent revenue loss and ensure accurate and timely billing of services provided.
• Support the organization in meeting its financial goals. Travel to clients' sites as needed to conduct assessments and to provide education and training related to findings.
• Respond to clients' questions and audit requests in a timely manner.
• Meet and or exceed the department productivity and quality standards.
• Review CMS, OIG, and other pertinent government websites to keep abreast of all charge capture guidelines & how they may impact revenue.
• Maintain thorough understanding of government rules and regulations, generally accepted auditing standards and common audit procedures and techniques.
• Other Preferred Knowledge, Skills and Abilities:
• Working knowledge of CPT/HCPCS/Revenue codes, charge capture and billing best practices, and government and non-government reimbursement guidelines.
• Strong organization skills.
• Highly motivated and self-starter with ability to complete assignments within time constraints and deadlines.
• Ability to thrive in a dynamic & fast paced work environment.
• Experience in physician and hospital operations, compliance and provider relations
• Minimum Education:
• Current RN or LPN Licensure
• Certifications:
• Candidate must have and keep current at least one of the following professional certifications or other approved job relevant certification:
• CCDI (Certified Clinical Documentation Improvement)
• CCS (Certified Coding Specialist)
• RHIA (Registered Health Information Administrator)
• RHIT (Registered Health Information Technician)
• COC (Certified Outpatient Coder)
• PMP (Project Management Professional)
• CPMA (Certified Professional Medical Auditor)
• Join an award-winning company
• Five-time winner of "Best in KLAS" 2020-2022, 2024-2025
• Black Book Research's Top Revenue Cycle Management Outsourcing Solution 2021-2024
• 22 Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in Revenue Cycle 2019-2024
• Leader in Everest Group's RCM Operations PEAK Matrix Assessment 2024
• Clarivate Healthcare Business Insights (HBI) Revenue Cycle Awards for strong performance 2020, 2022-2023
• Energage Top Workplaces USA 2022-2024
• Fortune Media Best Workplaces in Healthcare 2024
• Monster Top Workplace for Remote Work 2024
• Great Place to Work certified 2023-2024
• Innovation
• Work-Life Flexibility
• Leadership
• Purpose + Values
• Bottom line, we believe in empowering people and giving them the tools and resources needed to thrive. A few of those include:
• Associate Benefits - We offer a comprehensive benefits package designed to support the physical, emotional, and financial health of you and your family, including healthcare, time off, retirement, and well-being programs.
• Our Culture - Ensemble is a place where associates can do their best work and be their best selves. We put people first, last and always. Our culture is rooted i

Benefits

Additional Information

Thank you for considering a career at Ensemble! Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country. Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference! O.N.E Purpose: Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations. Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation. Striving for Excellence: Execute at a high level by demonstrating our "Best in KLAS" Ensemble Difference Principles and consistently delivering outstanding results.

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