Job Description:
• 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.
Requirements:
• 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
Benefits:
• Competitive benefit package including medical, dental, vision and 401(k) plan.