Nurse Auditor

University Medical Center of Southern Nevada • Las Vegas, NV

5d • Onsite

About The Position

As an academic medical center with a rich history of providing life-saving treatment in Southern Nevada, UMC serves as the anchor hospital of the Las Vegas Medical District, offering Nevada’s highest level of care to promote successful medical outcomes for patients. UMC is a Level I Trauma Center, home of the ONLY Verified Burn Center, and Transplant Center. In 2026, we became the FIRST and ONLY Magnet®-Recognized hospital in the state, reflecting UMC's nursing professionalism, teamwork, and superiority in patient care. Position Summary: Responsible for conducting hospital bill charge audits by reviewing medical records to verify services were provided and charges are appropriate, identifies overcharges, undercharges and unbundled items per carrier contract and industry standards.

Requirements

• Graduation from an accredited school of nursing
• Three (3) years' experience in clinical nursing
• Two (2) years of utilization management or other chart auditing experience
• Valid state license as a Registered Nurse
• Experience submitting Nevada Medicaid Authorizations Requests
• Knowledge of CMS Coding/Billing requirements
• EPIC Experience
• Previous Utilization Management Experience
• Experience in Chart Auditing
• Experience in developing denial appeal responses
• Knowledge of Medical review, chart audits, and quality improvement processes
• Knowledge of compliance regulations related to documentation, coding, and billing requirements
• Knowledge of clinical pathways, disease state management and utilization review criteria
• Knowledge of Medicare/Medicaid guidelines and other relevant regulations and standards
• Knowledge of HIPAA Privacy and Security Rules
• Knowledge of auditing concepts and principles
• Knowledge of reviewing medical records and coding documents according to standard practice
• Knowledge of department and hospital safety practice and procedures
• Knowledge of patient rights
• Knowledge of age specific patient care practices
• Knowledge of infection control policies and practices
• Knowledge of handling, storage, use and disposal of hazardous materials
• Knowledge of department and hospital emergency response policies and procedures
• Skill in analyzing and evaluating medical information and applying clinical review guidelines or judgement to make clinical determinations
• Skill in reviewing and verifying accuracy of data
• Skill in reviewing medical records and coding documents according to standard practice
• Skill in using initiative and independent judgment within general policy guidelines
• Skill in multi-tasking in a fast-paced working environment
• Skill in preparing clear and concise reports, correspondence and other written materials
• Skill in using computers and related software applications
• Skill in communicating with a wide variety of people from diverse socio-economic and ethnic backgrounds
• Skill in establishing and maintaining effective working relationships with all personnel contacted in the course of duties
• Skill in efficient, effective and safe use of equipment

Responsibilities

• Conducting hospital bill charge audits by reviewing medical records to verify services were provided and charges are appropriate
• Identifies overcharges, undercharges and unbundled items per carrier contract and industry standards.

Benefits

• EMPLOYER-PAID PENSION PLAN (NEVADA PERS)
• COMPETITIVE SALARY & BENEFITS PACKAGE

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED