AIS- Nurse Auditor
Location: Woodbridge New Jersey
Description: Concentra Inc. is looking of AIS- Nurse Auditor right now, this job will be placed in New Jersey. For detail informations about this job opportunity kindly see the descriptions. JOB SUMMARY:
The Nurse Auditor will provide recommendations to the insurance carrier in regards to billing submission over $10K for care provided to eligible injured parties in accordance with carrier guidelin! es for desk audits. This is a full-time position, and the nurse must be available 9AM-5PM Monday thru Friday.
MAJOR DUTIES AND RESPONSIBILITIES:
Review of bills including HFCA and UB92 bills on injured parties, involved in automobile accident cases including itemized billing submission in relation to clinical documentation during the course of a desk audit
Perform utilization review per technical guidelines established by Concentra
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
Must be a Registered Professional Nurse in the state of New Jersey in good standing. CPC and/or CHCQM preferred, but not required
Required Skills
Required Experience
QUALIFICATIONS:
Registere! d Nurse with active, unencumbered New Jersey licensure
Must be able to work in home environment with high speed cable access
Knowledge of CPT, IDC-9 codes, NCCI Edits, AMA and AAOS guidelines in accordance with NJ PIP statute concerning adjudication of bills
Ability to handle multiple tasks
Ability to work under moderate supervision
Ability to work in a home environment (requires broadband internet access such as cable or Verizon FIOS â€" DSL and Satellite are not acceptable)
Knowledge of Microsoft Office applications a plus
We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, special disability or medical or veteran status in accordance with federal law. In addition, Concentra Managed Care, Inc. complies with applicable state and local laws prohibiting discrimination in employment in every jurisdiction in which it main! tains facilities.
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If you were eligible to this job, please email us your resume, with salary requirements and a resume to Concentra Inc..
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This job starts available on: Wed, 14 Aug 2013 07:54:32 GMT