East Jefferson General Hospital
Nurse Auditor is responsible for auditing pe patient request and assigned audits per PFS Director and/or Supervisor. Nurse Auditor utilizes X-Claims and Med Assets Charge Capture Audit (CCA) work queue applications to preformpending audits and shares administrative duties with PFS Charge Services Team. Nurse Auditor reviews daily APC grouper edits from Health Information Management(HIM) Department. Responsible for the review of accounts, comparing claims to documentation contained in the medical record, assessing the accuracy of the claim and effectiveness of the charging system throughout the hospital, particularly the Charge Description Master (CDM). Responsible for the documenting needed debits and credits, adjustments needed on claims, and making recommendations to the Director of PFS and appropriate team members for improvements in process. The Nurse Auditor is responsible for monitoring statistical data based on audit results and effectively dealing with ancillary departments to correct charge Inequities. Responsible for reviewing utilizing the Decision Support CPT Averaging Application and CS Pricing Tool. Nurse Auditor represents PFS on assigned Committees to share trends, charging issues and shares with PFS Leadership Team.
Must be LPN with 3-5 years of clinical experience and at least 2 years of auditing experience. Familiarity with coding, claim review, medical records review, and Charge Description Master (CDM) is essential. Must have working knowledge of Word and Excel. Strong Financial background is desirable. Must have current LPN license.
daily reports to provide accurate billing data assigned. In addition, the nurse auditor is responsible for price estimates requested by patients and physician's
Patient Financial Services