Nurse Auditor 9/16/2017
Cambia Health Solutions
JOB DESCRIPTIONAPPLY OVERVIEW
Tacoma, WA; Burlington, WA; Portland, OR; Salt Lake City, UT; Lewiston, ID, Bosie, ID
Bring your experience to a role where you will:
* Utilize clinical expertise to plan, coordinate, conduct and report on post service audits to ensure accuracy of billed charges.
RESPONSIBILITIES & REQUIREMENTS
* Demonstrated competency in claim review and experience using billing and claims forms.
* Proven knowledge of medical and surgical procedures and other healthcare practices.
* Proven competency to apply clinical expertise to ensure compliance with medical policy.
* Knowledge in reading and interpreting medical records and patient data with an ability to communicate effectively with clinical and non-clinical staff.
* Knowledge of personal computer software, such as Microsoft Word, Excel, PowerPoint and Access.
* Ability to prepare and present clear and concise written narratives and reports.
* MCG experience highly preferred.
Normally to be proficient in the competencies listed above:
* Nurse Auditor I would have a Bachelor's Degree in Healthcare and 3 years of experience in a clinical setting, health insurance, coding/claims review, case management or equivalent combination of education and experience.
Required Licenses, Certifications, Registration, Etc.
* Current unrestricted license as an Registered Nurse within either OR, WA, ID or UT
General Functions and Outcomes
* Conducts coding audits, quality assurance assessments of claims, reviews statistical samples and analyzes for risk.
* Applies nursing expertise to ensure compliance with medical policy, medical necessity guidelines and accepted standards of care.
* Conducts audits to determine if claims adhere to specific provider and hospital contracts.
* Ensures that medical claims, medical records and other documentation essential to proper billing is in compliance with federal regulation, company policies and industry standards.
* Develops written audit findings with respect to contractual compliance, recommendations for improved contracts, and other matters identified during the audit.
* Writes audit reports, as applicable. Assesses and communicates the level of risk associated with the audit issues identified in the report.
* Conducts surveys of complex audit areas to define the scope and objectives of audits.
* Assists in the development of overall audit plans, including comprehensive audit programs that identify specific procedures and tests designed to achieve the audit objectives.
Regence employees are part of the larger Cambia family of companies, which seeks to drive innovative health solutions. We offer a competitive salary and a generous benefits package. We are an equal opportunity employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A drug screen and background check is required.
Regence is 2.2 million members, here for our families, co-workers and neighbors, helping each other be and stay healthy and provide support in time of need. We've been here for members more than 90 years. Regence is a nonprofit health care company offering individual and group medical, dental, vision and life insurance, Medicare and other government programs as well as pharmacy benefit management. We are the largest health insurer in the Northwest/Intermountain Region, serving members as Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regence BlueShield (in Washington). Each plan is an independent licensee of the Blue Cross and Blue Shield Association.
If you re seeking a career that affects change in the health care system, consider joining our team at Cambia Health Solutions. We advocate for transforming the health care system by making health care more affordable and accessible, increasing consumers engagement in their health care decisions, and offering a diverse range of products and services that promote the health and well-being of our members. Cambia's portfolio of companies spans health care information technology and software development; retail health care; health insurance plans that carry the Blue Cross and Blue Shield brands; pharmacy benefit management; life, disability, dental, vision and other lines of protection; alternative solutions to health care access and free-standing health and wellness solutions.