[Hiring] Nurse Auditing Specialist @S1 Medical

Role Description

The Nurse Auditing Specialist (“NAS”) is the lead resource within S1 Medical to review medical bills of certain size or type and attempt to identify any medical bill charges or practices that are not in line with the support medical documentation, the injury itself, or comparable commercially reasonable reimbursement reference tools. Additionally, the NAS will aid in the review of medications being authorized against Medicare medical guidelines.

The role of the NAS is important for multiple reasons:

• Directly supports the launch of an internalized role and process at S1.
• Directly involved in the most cost-effective area of the client’s medical spend.
• Provides S1 with its first internal clinical resource for staff.

Core responsibilities include, but are not limited to the following:

• Represent S1 as an internal clinical resource, maintaining necessary RN credentials and licensures.
• Utilize nursing experience to review supporting documentation that accompany medical bills. Ensure medical billing is aligned with medical notes.
• Utilize multiple medical pay data resources to validate the cost of medical charges as presented on medical bills.
• Collaborate with CBM-PM to ensure a smooth workflow to accomplish bill auditing steps.
• Collaborate with CBS-PM to establish and refine a personal “style” & strategy related to reducing the costs of medical charges, explaining the reasons for medical charge reduction, and communicating with medical providers and facilities when needed.
• In an organized and systematic fashion, keep up on clear and concise documentation of findings so that they are referenceable in the future. There will be multiple locations where documentation is required.
• Provide clear and deliberate instructions to medical bill auditors and negotiators as it relates to your audit findings, and these being transferred into medical bill review system or communicated to providers.
• Maintain a process of self-management and organization so that both individual medical bills, as well as tasks associated with those medical bills, are not lost.
• Attend at least 2 events annually related to workplace culture improvement and/or the role of business in progressing social or environmental initiatives.

Qualifications

• Active Registered Nurse (RN) license and credentials
• Self motivated, especially in a virtual work environment
• Proven ability to make sound, timely decisions and/or ask for support when needed
• Excellent communication skills, with the ability to interact clearly and professionally
• High attention to detail with accurate and 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 with the ability to work cross-functionally with team members

Benefits

• Opportunity to play a key role in a growing organization, directly contributing to client satisfaction and organizational success.
• Supportive environment where accuracy, accountability, and collaboration are highly valued.
• Competitive salary and comprehensive benefits package.