Registered Nurse -Audit-RN-Full time

UT Southwestern Medical Center
13 Oct 2017
13 Oct 2017
Job role
Contract type
Full time
This position is security–sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information

Salary Negotiable

Experience and Education
Graduate of an accredited nursing program with a current license to practice in the state of Texas. Certification as RN. Five (5) years of clinical experience as a Registered Nurse, including at least 2 years performing utilization review, charge audit, case management or denial/appeal functions in an acute care hospital. Principles of Managed Care, Medicare/Medicaid reimbursement required.

Job Duties
  • Prepare for and conduct audits requested by governmental and managed care payors, comparing clinical documentation to charges billed to identify any possible under/over charges; documents and sends audit results to payor organizations or external auditors for review and resolution as applicable; maintains communication with auditors and other relevant individual/organizations until all discrepancies are resolved.
  • Performs internally defined audits to identify under/over charges; reviews charges posted to the claims against the necessary clinical documentation to identify any possible under/over charges; documents audit findings and sends results to appropriate departments.
  • Performs charge audits as requested by patients; reviews billed charges for patients who are disputing charges by comparing the charges against all necessary clinical documentation and looking for discrepancies; documents audit results; posts corrections to accounts; communicates back to appropriate departments and sends to PFS/Customer Service for rebilling if necessary.
  • Conducts review of accounts that have not been paid according to their contractual agreement because of denied charges; compares charges with clinical documentation to determine the validity of the denial and/or identifies any charge discrepancies; documents audit findings; posts adjustments to accounts and sends to appropriate department for rebilling and/or payment correction if necessary.
  • Assists departments with the charge reconciliation process. Works with all relevant hospital departments to provide timely education on how to correct or improve processes that have been found to be deficient.
  • Works with various staff and departments such as Health Information Management, clinical nursing units, physicians and others to obtain the information necessary to perform account audits.
  • *Other Duties: Performs other duties as assigned.
UTSouthwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. In accordance with federal and state law, the University prohibits unlawful discrimination, including harassment, on the basis of: race; color; religion; national origin; gender, including sexual harassment; age; disability; citizenship; and veteran status. In addition, it is UTSouthwestern policy to prohibit discrimination on the basis of sexual orientation, gender identity, or gender expression.

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