Nurse auditors apply the knowledge of hospital services, health care treatments and medical terminology in order to audit charges on bills and support hospital efforts to maximize reimbursements.
Most are employed at hospitals or medical clinics, but some nurse auditors work for insurance or pharmaceutical companies. Types of audits supported include under/over charge audits, patient request/complaint audits, and other special request audits.
Nurse auditors job responsibilities:
-review medical records and hospital accounting sheets to check for their accuracy
-responsible for performing pre-payment desktop clinical audits of hospital claims and ensuring accuracy by performing a line by line review of appropriate medical records
-review coding of professional bills utilizing requested procedural notes
-contact provider’s representative to resolve billing issues or to negotiate claim.
-monitor turnaround time to ensure timely processing of claims
Nurse auditor requirements: Nurse auditors must be registered, licensed nurses.They should have significant experience reviewing medical records or working in a hospital environment. Their job requires some accounting and financial knowledge
Average annual salary for nurse auditors is $99,000. Nurse auditors earning about $30,000 more per year on average than other nurses.