Nurse Auditor at CCC Information Services Inc

Remote | Part-time
CCC Information Services Inc

Per Diem Nurse Auditor

Posting Locations: Iselin, NJ; Virtual, USA

Job Description Summary

The Nurse Auditor will provide recommendations to the insurance carrier in regards to billing submission over carrier guidelines for Audit Bill Criteria for Facility and Physician desk audits. This is a per diem position (approximately 20-29 hours per week). The Nurse Auditor will work from home, in a remote office environment.

Job Duties

  • Complete Desk Audits of provider and facility billing submissions
  • Perform utilization review per client directed criteria
  • Determine if the bill requires physician review for level of care issues, causality or medical necessity
  • Determine if CPT codes reviewed are supported by documentation provided and eligible for reimbursement per NCCI Edit guidelines
  • Other duties as assigned

Working Conditions:

  • This position is a Field (Remote-work from home) opportunity.

Qualifications

Education/Credentials:

  • A minimum of an Associate’s degree and RN is required, BSN is preferred
  • Must possess an active, unencumbered license in state of residence
  • Required to become HCQM certified by the ABQAURP within one year of hire

Job Related Skills/Experience:

  • 3 years previous case management and/or UR experience with strong clinical back ground is required
  • Minimum 2 years prior medical bill audit experience is preferred
  • Knowledge of CPT, IDC-9/10 codes, NCCI Edits, AMA and AAOS guidelines in accordance with NJ PIP statute concerning adjudication of bills is required
  • Knowledge of N.J.A.C 11:3-29.4 and 11:3-29.5 regulations is required
  • Ability to handle multiple tasks and work under moderate supervision is required.
  • Strong problem solving, critical thinking and interpersonal skills are required
  • Excellent written and verbal communication skills are required. Knowledge of computers, Excel, Word and Windows is required
  • CPC preferred but not required
  • Ability to work in a home environment (requires broadband internet access such as cable or Verizon FIOS – DSL and Satellite are not acceptable)

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