PortlandRecruiter Since 2001
the smart solution for Portland jobs

Nurse Auditor

Company: Direct Staffing Inc
Location: Portland
Posted on: February 16, 2020

Job Description:

Company Description


Job Description

Nurse Auditor

Portland, OR

Exp 5-7 years

This position can be located in Tacoma, WA; Seattle, WA; Burlington, WA; Salt Lake City UT; Medford, OR; Portland, OR; Lewiston, ID

Candidates must work at least 6 months in the office before telecommute work will be considered

Job Purpose
--- Plan, coordinate, conduct and report on post payment claims audits and performs related special projects as assigned.

Key Qualifications and Experience:
--- Proven knowledge of medical and surgical procedures and other healthcare practices and trends.
--- General computer skills (including use of Microsoft Office, specifically Excel and Outlook, internet search).
--- Familiarity with health care documentation systems.
--- Strong verbal, written and interpersonal communication and customer service skills.
--- Ability to communicate audit outcomes and testing results with other staff within the company who are both medically and non-medically oriented.
--- Ability to interpret policies and procedures and communicate complex topics to others.
--- Strong organizational and time management skills with the ability to manage workload independently.
--- Ability to think critically and make decisions within individual role and responsibility.
--- Proven ability in developing and following an audit program.
--- Demonstrated competency in claim review and experience in using billing and claims forms (UB, CMS, and HCFA).

Normally to be proficient in the competencies listed above:
--- Nurse Auditor would have a/an Associate or Bachelor's Degree in Nursing or related field and 5 years of hospital quality management, coding or medical auditing experience or equivalent combination of education and experience.

Required Licenses, Certifications, Registration, Etc.
--- Registered nurse (RN) license (must have a current unrestricted RN license for medical care management).
--- Certified Coder certified with the American Academy of Professional Coders (AAPC) or the American Health Information Management Association (AHIMA) preferred.

General Functions and Outcomes:
--- Applies clinical expertise and judgment to ensure payments comply with medical policy, medical necessity guidelines, and accepted standards of care.
--- Utilizes evidence-based criteria that incorporates current and validated clinical research findings. Practices within the scope of their license.
--- Understands and analyzes complex provider and hospital contracts in order to ensure payments are for covered services.
--- Conducts coding audits, quality assurance assessments of claims, reviews statistical samples and analyzes for risk.
--- 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.
--- Identifies problems or needed changes, recommends resolution, and participates in quality improvement efforts.
--- Responds in writing or by phone to members, providers and regulatory organizations in a professional manner while protecting confidentiality of sensitive documents and issues.
--- Provides consistent and accurate documentation.
--- Plans, organizes and prioritizes assignments to comply with performance standards, corporate goals

Skills and Certifications
RN license in either WA, OR, ID, UT
Certified Professional Coder preferred

Ideal Candidate We have several positions open, with one being specific for working with Skilled Nursing Facilities. We would prefer candidates with specific experience in Skilled Nursing Facilities or a varied skill set in a clinical setting, with chart auditing experience strongly preferred.
Ideal Candidate should have worked for the following company(ies): Any other health insurance plan

Additional Information

All your information will be kept confidential according to EEO guidelines.

Direct Staffing Inc

Keywords: Direct Staffing Inc, Portland , Nurse Auditor, Accounting, Auditing , Portland, Oregon

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category

Other Accounting, Auditing Jobs

Insurance and Financial Sales - LIFE INSURANCE LICENSED REQ'D (Portland,OR)
Description: CURRENT LIFE INSURANCE LICENSE REQUIRED TO BE CONSIDERED Are you an individual with a strong desire to succeed in the business world and help families at the same time We have a wide range of mortgage (more...)
Company: The Alliance
Location: Portland
Posted on: 02/19/2020

Assurance Services Senior - External Audit
Description: Assurance Services Senior - External AuditAssuranceRequisition POR000V4Post Date 7 hours agoFrom small businesses to some of the worlds best-known brands, our clients count on reliable financial statements, (more...)
Company: EY
Location: Portland
Posted on: 02/19/2020

Assistant Controller
Description: Ref ID: 03600-9502459923Classification: Assistant ControllerCompensation: DOERobert Half Management Resources is seeking an Assistant Controller for a fast-paced company in the Portland/Vancouver area. (more...)
Company: Robert Half
Location: Portland
Posted on: 02/19/2020

Administrative Support Specialist, Save First Financial
Description: Administrative Support Specialist, Save First Financial ul li Jobs li Login li Portland, OR, USA li Hourly li Full Time li Catholic CharitiesCompensation is commensurate with skills and (more...)
Company: Catholic Charities of Oregon
Location: Portland
Posted on: 02/19/2020

Senior Revenue Accountant
Description: Ref ID: 03600-0011343002Classification: Sr. AccountantCompensation: DOESue Sumrell Click Here to Email Your Resum-- is recruiting for an exciting SaaS company with a 35 growth rate This is an exceptional (more...)
Company: Robert Half
Location: Portland
Posted on: 02/19/2020

Enterprise Testing Sr Associate - Review Lead
Description: Job DescriptionImportant Note: During the application process, ensure your contact information email and phone number is up to date and upload your current resume when submitting your application for (more...)
Company: Wells Fargo Bank
Location: Canby
Posted on: 02/19/2020

Associate Actuary
Description: Jobs Rated 10th Description The Associate Actuary, Analytics/Forecasting analyzes and forecasts financial, economic, and other data to provide accurate and timely information for strategic and operational (more...)
Company: Humana
Location: Vancouver
Posted on: 02/19/2020

Financial Consultant - Portland, OR
Description: Job Description:With your extraordinary knowledge and incomparable integrity, we know that clients invest their trust in you. Join a team that also invests in you with key product and service offerings, (more...)
Company: Fidelity Investments
Location: Mulino
Posted on: 02/19/2020

Financial Consultant - Portland, OR
Description: Job Description:With your extraordinary knowledge and incomparable integrity, we know that clients invest their trust in you. Join a team that also invests in you with key product and service offerings, (more...)
Company: Fidelity Investments
Location: West Linn
Posted on: 02/19/2020

Description: Bookkeeperjob details: ul li location:Portland, OR li salary: 15 - 18 per hour li date posted:Friday, February 14, 2020 li experience:Entry Level li job type:Temp to Perm li industry:Administrative (more...)
Company: Randstad
Location: Portland
Posted on: 02/19/2020

Log In or Create An Account

Get the latest Oregon jobs by following @recnetOR on Twitter!

Portland RSS job feeds