Nurse Auditor PHX
THIS JOB HAS EXPIRED Description
PHX is the leader in clinical bill review and audit, utilizing state-of-the-art technology and a team of experienced Nurse Auditors who perform pre-payment desktop audits on inpatient and outpatient medical claims. Ranked as one of the Fastest Growing and Best Places to work in NJ in 2013, our Nurse Auditors combine a clinical and financial approach to determine appropriateness of billing, uncovering data entry or pricing errors; unbundling; inappropriate, unsubstantiated or improper charges; cost to charge ratio analysis; never event identification; experimental/investigational reviews; and other practices that inflate billed amounts.
Our staff represents over 175 years of combined experience in auditing, utilization review and case management. This expertise combined with their payor, provider and clinical backgrounds, enables them to review claims efficiently and uncover substantial opportunities for cost savings.
We currently have an exciting opportunity for a seasoned Nurse Auditor to join our growing Bill Review & Audit department located in Bedminster, NJ. This is an outstanding opportunity for a savvy individual with great communication skills to join one of the fastest growing companies in healthcare.
MAJOR RESPONSIBILITIES INCLUDE:
Review daily in-process report for new assigned claims.
Request documentation from Office Assistant needed to complete clinical review of assigned claims.
Review coding of professional bills utilizing requested procedural notes.
Review itemized bill and medical records for medical appropriateness and inconsistencies by performing a line by line clinical review of claim.
Research unfamiliar procedures as needed via web.
Contact provider?s representative to resolve billing issues.
Contact provider?s representative to negotiate claim.
Confirm repricing information with provider.
Provide status of outstanding claims upon request.
Prepare management reports of findings for submission to PHX client.
Monitor turnaround time to ensure timely processing of claims.
Assist with provider?s payment inquiries to resolve disputes.
Serve as additional clinical and non-clinical resource to other members of the bill review team.
LPN license or RN
2 ? 5 years of clinical auditing experience or case management or utilization review
Excellent written and verbal communication skills
Exceptional organizational skills
Proficient knowledge of Microsoft Outlook, Word, and Excel
Detail-oriented and able to work in a fast paced environment.
Join the PHX team and achieve the Work-Life Balance, Job Fulfillment, Intellectual Challenge and Rewards & Recognition that you've been searching for! PHX is proud to be an Equal Opportunity Employer
||Bedminster, NJ |
THIS JOB HAS EXPIRED