Nurse Auditing Specialist

S1 Medical

About The Position

The Nurse Auditing Specialist (NAS) is the lead internal clinical resource at S1 Medical for reviewing medical bills of certain sizes or types. The role identifies charges or billing practices that are inconsistent with supporting medical documentation, the injury itself, or comparable commercially reasonable reimbursement reference tools. The NAS also helps review medications being authorized against Medicare medical guidelines. This role supports the launch of an internalized auditing role and process, focuses on a cost-effective area of client medical spending, and provides S1 staff with its first internal clinical resource. The position works with bill auditors, negotiators, medical providers, facilities, and internal partners to document findings, guide audit actions, and help reduce medical charges. The role also includes attending at least two annual events related to workplace culture improvement and/or the role of business in social or environmental initiatives.

Requirements

Active Registered Nurse (RN) license and credentials.
Self-motivated, especially in a virtual work environment.
Ability to make sound, timely decisions and ask for support when needed.
Excellent communication skills and ability to interact clearly and professionally.
High attention to detail and accurate, thorough documentation skills.
Ability to follow established protocols while exercising judgment when needed.
Strong organizational and multitasking abilities in a high-volume environment.
Collaborative mindset and ability to work cross-functionally with team members.

Responsibilities

Represent S1 as an internal clinical resource while maintaining required RN credentials and licensure.
Review supporting documentation accompanying medical bills and ensure billing aligns with medical notes.
Use multiple medical payment data resources to validate the cost of charges on medical bills.
Collaborate with CBM-PM to ensure a smooth workflow for bill auditing steps.
Collaborate with CBS-PM to establish and refine approaches to reducing medical charges, explaining reductions, and communicating with medical providers and facilities when needed.
Maintain clear, concise, organized documentation of findings in the required locations for future reference.
Provide clear instructions to medical bill auditors and negotiators based on audit findings, including information to be entered into the medical bill review system or communicated to providers.
Manage and organize work so that medical bills and related tasks are not lost.
Attend at least two annual events related to workplace culture improvement and/or the role of business in progressing social or environmental initiatives.