RN Nurse Auditor- Patient Financial Services FT

Hunt Regional Healthcare•Greenville, TX

About The Position

The RN Nurse Auditor is responsible for auditing patient charts against patient accounts to ensure billing accuracy and regulatory compliance. Audits may be requested or concurrent, with results reported monthly. The role provides guidance when diagnoses or procedures require clarification regarding medical necessity and appropriateness, interacts with patients to resolve disputed claims, completes daily charge rejection reports, assists with root cause analysis of errors and trends, and supports ongoing education for ancillary departments. The position also monitors charge-capture accuracy, researches and resolves account and billing issues, and communicates with management to address errors and reduce lost revenue. The auditor works across multiple systems and supports internal and external customers while meeting production, financial, and quality goals. The role promotes the hospital district’s values, compliance requirements, HIPAA standards, and commitment to quality and customer service.

Requirements

At least two years of experience in medical and/or surgical nursing.
Texas licensure as a Registered Nurse.
Ability to interpret and generate written correspondence using proper grammar, spelling, and composition.
Computer knowledge and experience with automated systems.
Ability to operate office equipment, such as copy machines, fax machines, and printers.
Ability to work independently with minimal supervision.
Good verbal and written communication skills.
Prior experience involving public contact.

Nice To Haves

Good understanding of patient accounting and medical charting.

Responsibilities

Audit patient bills against medical records for accuracy, including requested, random, and concurrent audits.
Address and return account inquiries within 24 hours.
Monitor overcharges and undercharges resulting from charge-capture errors.
Identify departments with inadequate charge documentation or frequent late charges.
Communicate charge-capture issues to management and help minimize lost revenue.
Serve as charge-capture staff and perform concurrent audits for designated departments.
Research and troubleshoot issues as needed.
Assist with root cause analysis when errors or trends are identified.
Prepare monthly audit results reports summarizing project status, challenges, successes, and audited accounts; present reports to appropriate leaders or committees when requested.
Provide ongoing education to ancillary departments.
Resolve issues and concerns amicably and promptly, involving the PFS Leader when needed.
Take corrective action to resolve charge errors, including corrections, data extraction, and education.
Serve as a resource for others within the District.
Assist the manager, director, and CFO upon request, and perform special duties or projects as assigned.
Work in multiple systems while meeting production, financial, and quality goals.
Enter accurate and thorough comments on each patient account.
Promote excellent customer service with patients, physicians, coworkers, and other internal and external customers.
Reinforce HMHD values and promote its Compliance Plan and understanding of applicable laws and standards.
Complete required corporate integrity and compliance training and demonstrate understanding of training materials.
Ensure department employees complete compliance training on time in accordance with HMHD policies.
Assist the Compliance Officer and Executive Compliance Committee in identifying high-risk departmental issues.
Comply with HIPAA standards.
Communicate effectively, listen actively, and use appropriate communication channels.
Adapt and respond to change; maintain punctuality, follow call-in policy, and adhere to hospital and department dress codes.
Contribute to the achievement of excellence in healthcare consistent with the mission and vision of Hunt Memorial Hospital District.