Top 4 Nurse auditor Jobs in Baltimore Md

Nurse Auditor
David-James —Baltimore, MD
- $75,000 - $85,000 a year
- Full-time
- Hybrid work
- 5 years
- Mid-level
- Older adults
- Continuing education credits
- Health insurance
Clinical Quality Registered Nurse
Porter Cares, Inc. —Baltimore, MD
- $80,000 - $85,000 a year
- Weekends as needed
- Nursing
- Up to 50% travel
- RN License
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HIM Clinical Document Specialist - DTC Hybrid
University of Maryland Medical System —Baltimore, MD
Collaborates with providers, leadership and teams to assist with the development and implementation of specific tools and educational materials to support…
5d
HIM Clinical Document Specialist, Hybrid, DTC
University of Maryland Medical System —Baltimore, MD
Collaborates with providers, leadership and teams to assist with the development and implementation of specific tools and educational materials to support…
$38.67 - $58.05 an hour

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Nurse Auditor

David-James -
Baltimore, MD

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Job Details

Full-time
$75,000 - $85,000 a year

Benefits

Continuing education credits
Health insurance
Dental insurance
401(k)
Paid time off
Vision insurance
401(k) matching
Life insurance
Referral program

Qualifications

5 years
Mid-level

Full Job Description

We are looking for a strong clinical nurse auditor to become part of our fast growing government-based healthcare practice …

Integrity

Entrepreneurial

Self-Motivated

Passionate

Team Player

Results Oriented

Reliable

Professional

Nurse Auditor wanted …

Established in 2005, our audit firm, based in the Baltimore County, MD area is dedicated to health care compliance of government providers, health plans and contractors. Government health care compliance services represent a large portion of our firm’s clients. We audit some of the largest & most complex health care organizations in the country utilizing a team approach drawing on various areas and levels of expertise.

As a Nurse Auditor on our Assurance Team, you will be involved with performance audits, examinations and agreed-upon procedure engagements. You will also apply your experience and knowledge of patient care and/or operational processes by making suggestions to improve client internal controls and operational procedures.

Position Summary: Nurse Auditor

The Nurse Auditor is a clinically experienced professional who has a strong background in patient care, patient delivery systems and/or familiarity with Medicare’s coding guidelines. The Nurse Auditor will participate in audits of Part C Organization Determinations, Appeals and Grievances (ODAG), Special Needs Plan Model of Care (SNP MOC), and/or Programs of All-Inclusive Care for the Elderly (PACE). The position is responsible for reviewing policies and procedures, internal controls, and claims / medical records to determine an organization’s compliance with Medicare rules and regulations. Extensive training will be provided along with working on various teams to gain direct experience on the process.

Requirements :
Must be a Registered Nurse with a current license, and clinical documentation, medical necessity, and/or utilization review experience.

Bachelor’s degree in nursing with 5+ years related healthcare experience and a broad knowledge of medical claims billing/payment required.

Desirable:
Direct experience in medical chart review for inpatient claims and Part C Access.

Experience with medical necessity determinations applying clinical judgment, utilizing medical necessity criteria and screening tools based on nationally recognized tools.

Familiarity with Coverage Determinations, Reconsiderations, Appeals and/or Grievance processes and regulations.

Prior auditing experience in either a provider or payer environment.

Working knowledge of DRG, ICD-9/10, CPT and HCPCS codes.

Working knowledge of provider billing guidelines, payer reimbursement policies and related industry-based standards.

Proficient with Word and Excel.

Job Type: Full-time, The nurse auditor position is a hybrid-remote position. Initial and periodic training will be performed at David-James’ offices. Limited travel to auditee locations may be required.

Job Type: Full-time

Salary: $75,000.00 – $85,000.00 per year

Benefits:
401(k)

401(k) matching

Continuing education credits

Dental insurance

Health insurance

Life insurance

Paid time off

Referral program

Vision insurance

Supplemental pay types:
Bonus pay

License/Certification:
RN License (Required)

Work Location: Hybrid-Remote

Apply Now

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