The Nurse Auditor conducts hospital charge audits on claims paid at percent of billed charges to verify charges are appropriate and supported by documentation in the medical record. Charge audits identify overcharges, undercharges and unbundled items per carrier contract, industry standards and payer reimbursement policies.
Itemized Bill Review knowledge is required with regard to Unbundling Guidelines specific to payer policy, industry standards and Medicare Guidelines. The nurse will also be responsible for independent scheduling requiring flexibility and possible travel to provider location. The position requires strong clinical experience and technical skills.
Salary range $70,000 - $90,000
0-10% travel may be required.
For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits
The posted range is the hiring range for this role — a subset of the broader range available to employees over time — and reflects base salary across our national hiring scale. Final offers are based on several factors, including the candidate's skills and experience, internal pay equity, work location, market conditions for the role, and the specific scope and responsibilities of the position. The top of the range is reserved for candidates who notably exceed the requirements; the lower end applies to those with less experience or fewer preferred qualifications. For positions based in higher-cost zones (e.g., California, New York, New Jersey), actual compensation may exceed the posted range; your recruiter will share specifics during the process.
- Review medical records to verify services were provided as billed for Hospital Bill Audit reviews.
- Identify overcharges, undercharges and unbundled items.
- Identify unbundled items on the itemized bill specific to payer Unbundling Guidelines and provide references and rationale to support review findings.
- Onsite Travel – Maintain timely communication with Audit Coordinator regarding scheduling, completion and submission of audits. Abide by the EXL Travel policy while making travel arrangements for onsite audits.
- Scheduling Audits: Manage inventory and schedule audits timely by contacting the provider to schedule date and time to perform audits.
- Report any problems in the audit process to Manager for resolution.
- Comply with HIPAA and other regulations regarding the confidentiality of patient information.
- Conduct all job functions and responsibilities in accordance with all company Compliance, Information Security and Regulatory policies, procedures and programs.
- Minimum of 5+ years of acute care clinical experience in medical/surgical units
- Licensed Nurse with current active license
- Minimum 3+ years hospital bill auditing experience on high dollar claims paid at percent of billed charge, payer or provider side
- CPC, CCS or CMAS desired
- Excel proficiency
- Familiarity with basic data entry tasks
- Excellent interpersonal and communication skills
- Demonstrate ability to prioritize tasks and work independently