A Nurse Auditor is responsible for reviewing medical records and to determine if the documentation substantiates the quality of care, medical necessity, utilization, and coding of insurance claims. Typical work activities listed on the Nurse Auditor Resume are – reviewing remittance advice for denials and the appeal process; ensuring optimal billing methods meet the billing compliance standards; inspecting the organization’s accounts, billing procedures, and medical records; finding out overcharged bills, preparing audit reports, details of the discrepancy and relevant recommendations for improvements; and ensuring all records are filed properly.
Key skills that can highlight a resume include the following – competent knowledge in the field of accounting, finance, and auditing; familiarity with common medical terminologies, treatments, tests, and concepts; the ability to sort, compile and extract voluminous data; and strong leadership skills. To enter this occupation, a nursing degree and knowledge of CPT, ICD9-CM, and HCPCS are considered mandatory.
Objective : Dedicated Nurse Auditor with over two years of experience in quality assurance and compliance auditing. Proven ability to enhance clinical documentation accuracy and streamline charge capture processes. Committed to maintaining regulatory standards while supporting interdisciplinary teams to optimize patient care and operational efficiency.
Conducted thorough quality audits on surgical accounts, ensuring accurate documentation and billing practices.
Collaborated with management to identify and implement process improvements, enhancing service delivery.
Maintained strict adherence to compliance regulations, safeguarding patient confidentiality.
Supported the organization's compliance initiatives, demonstrating commitment to quality care.
Analyzed audit findings to provide actionable feedback for clinical departments.
Participated in continuous education to stay updated on healthcare regulations and best practices.
Trained staff on documentation standards to improve overall audit outcomes.
Experience
0-2 Years
Level
Entry Level
Education
BSN
Clinical Nurse Auditor Resume
Objective : Accomplished Clinical Nurse Auditor with 5 years of experience in enhancing clinical documentation and driving compliance with healthcare regulations. Expertise in auditing processes, identifying discrepancies, and fostering collaboration among healthcare teams to improve patient outcomes. Passionate about promoting quality care through meticulous review and education in clinical practices.
Skills : Emergency Department Nursing, Behavioral Health Compliance, Medical-surgical Auditing, Healthcare Administration, Interpersonal Skills
Description :
Conducted comprehensive audits of clinical records for third-party payers and patient requests.
Developed and maintained revenue integrity tools to enhance billing accuracy.
Assisted in the evaluation and management of denial appeals, improving recovery rates.
Supervised chargemaster liaison and utilization review teams to ensure compliance.
Secured DRG authorizations from various insurance carriers.
Educated hospital staff and physicians on compliance regulations for Medicare and Medicaid.
Supported the Director of Resource Management in overseeing case managers during absences.
Experience
2-5 Years
Level
Junior
Education
BSN
Nurse Auditor Resume
Headline : Experienced Nurse Auditor with 7 years in clinical documentation review and compliance auditing. Skilled in identifying discrepancies, enhancing charge capture accuracy, and training healthcare teams on best practices. Dedicated to ensuring adherence to regulatory standards while improving patient care through effective collaboration and precise documentation management.
Skills : Documentation Accuracy, Cost Containment, Utilization Review, Health Information Management, Clinical Auditing, Documentation Standards
Description :
Conducted detailed audits and clinical record reviews to ensure compliance with coverage requirements, physician orders, and regulatory standards.
Communicated findings to Compliance and Clinical Managers, facilitating timely resolution of identified issues.
Educated patient care teams on documentation best practices based on audit outcomes.
Participated in corrective action plans to address audit findings and enhance overall quality.
Provided recommendations for policy revisions to improve compliance and operational efficiency.
Engaged in clinical case conferences to evaluate patient progress and adjust care plans as needed.
Trained staff on auditing processes and documentation standards to elevate compliance knowledge.
Experience
5-7 Years
Level
Senior
Education
BSN
Healthcare Nurse Auditor Resume
Summary : Accomplished Healthcare Nurse Auditor with 10 years of experience in clinical documentation review, compliance auditing, and regulatory adherence. Expert in identifying discrepancies and optimizing charge capture processes, enhancing operational efficiency. Committed to fostering interdisciplinary collaboration to improve patient outcomes and uphold the highest standards of care.
Skills : Attention To Detail, Critical Thinking, Problem Solving, Healthcare Policies, Billing Procedures, Patient Care Standards
Description :
Analyzed Observation reports to identify and rectify errors in start and stop times.
Communicated findings to Nursing Department Leadership to facilitate timely corrections and staff education.
Reviewed and corrected Infusion and Injection charges in compliance with CMS regulations.
Resolved business office requests to amend billing edits effectively.
Engaged with the CCA Edit Program to enhance audit accuracy.
Collaborated with external vendors to streamline auditing processes.
Performed comprehensive audits across all clinical areas to ensure compliance with accreditation standards.
Experience
7-10 Years
Level
Management
Education
BSN
Nurse Auditor Resume
Summary : Accomplished Nurse Auditor with 10 years of expertise in clinical documentation analysis and compliance auditing. Proven track record in identifying discrepancies, enhancing documentation accuracy, and optimizing charge capture processes. Passionate about fostering interdisciplinary collaboration to uphold regulatory standards and improve patient outcomes.
Conducted thorough audits of medical billing to ensure accuracy and compliance with regulatory standards.
Mentored staff in best practices for clinical documentation and charge capture processes.
Collaborated with interdisciplinary teams to enhance patient care and operational efficiency.
Developed training programs to educate staff on compliance and documentation standards.
Maintained detailed records to support audit findings and regulatory compliance.
Analyzed audit results to identify trends and recommend improvements.
Participated in quality assurance initiatives to enhance overall healthcare delivery.
Experience
10+ Years
Level
Executive
Education
BSN
Quality Assurance Nurse Auditor Resume
Headline : Quality Assurance Nurse Auditor with 7 years of experience in clinical auditing and regulatory compliance. Expert in analyzing documentation for accuracy, identifying discrepancies, and implementing effective training programs. Passionate about enhancing patient care through meticulous review processes while fostering collaboration across healthcare teams to achieve optimal operational efficiency.
Skills : Patient Advocacy, Healthcare Regulations, Regulatory Compliance, Medical Coding
Description :
Conduct thorough audits of nursing documentation for compliance with regulations and standards.
Achieved $1.7 million in cost savings by identifying billing discrepancies.
Collaborated with department directors to rectify discrepancies and improve documentation accuracy.
Addressed patient inquiries regarding billing, ensuring accurate and timely corrections.
Conducted side-by-side audits of patient bills with insurance representatives to ensure compliance.
Review patient records to ensure accurate coding and billing practices are followed.
Facilitated in-service training for hospital staff on accurate documentation practices to enhance billing accuracy.
Experience
5-7 Years
Level
Consultant
Education
BSN
Nurse Auditor Resume
Objective : Results-oriented Nurse Auditor with two years of experience in clinical auditing and compliance verification. Demonstrated expertise in optimizing billing accuracy and enhancing documentation standards. Adept at collaborating with healthcare teams to ensure regulatory compliance and improve patient care outcomes.
Skills : Licensed Practical Nurse, Certified Medical Coder, Fraud Detection, Process Improvement, Ethical Standards, Regulatory Reporting
Description :
Conducted comprehensive clinical, concurrent, and defense audits to assess billing compliance and documentation accuracy.
Analyzed multiple reports, including the Late Charge Report and Batch Report, to ensure adherence to billing standards.
Reviewed denial logs to identify clinical aspects and recommend corrective actions.
Documented findings in the collection system, aiding in the maintenance of ChargeMaster Files.
Collaborated with departments to reduce unbilled items and charging errors, enhancing operational efficiency.
Performed audits on patient complaints to identify areas for service improvement.
Provided detailed feedback to interdisciplinary teams regarding documentation practices.
Experience
0-2 Years
Level
Fresher
Education
BSN
Regulatory Nurse Auditor Resume
Summary : With a decade of specialized experience as a Regulatory Nurse Auditor, I excel in ensuring compliance and accuracy in clinical documentation and billing practices. My expertise in conducting detailed audits and collaborating with healthcare teams enhances operational efficiency and patient care quality, while maintaining adherence to regulatory standards.
Develop and implement training programs for nursing staff on documentation standards.
Reviewed denied service records to assess medical necessity and support appeals.
Ensured timely resolution of appeals and grievances, adhering to regulatory timeframes.
Documented audit findings and tracked appeal information using relevant systems.
Generated detailed correspondence for providers and regulatory entities regarding audit outcomes.
Utilized InterQual criteria for evaluating inpatient admissions.
Collaborated with teams to address Medicare Compliance Audit findings effectively.
Experience
7-10 Years
Level
Senior
Education
BSN
Nurse Auditor Resume
Objective : Motivated Nurse Auditor with 5 years of focused experience in clinical documentation review and compliance auditing. Proficient in identifying discrepancies and enhancing billing accuracy while fostering collaboration among healthcare teams. Dedicated to upholding regulatory standards and driving quality improvements in patient care through comprehensive audits and targeted education.
Executed thorough charge audits at Trinity Medical Center to ensure billing accuracy.
Reviewed patient invoices for accuracy, verifying all chargeable services rendered during hospital stays.
Managed ER disputes and special audit requests effectively.
Conducted OIG and IDA audits to maintain compliance.
Facilitated monthly audit meetings with executive leadership to address discrepancies and strategize solutions.
Performed concurrent reviews of inpatient and outpatient records, providing documentation education for management.
Utilized Microsoft Office Suite for data management and reporting on audit findings.
Experience
2-5 Years
Level
Junior
Education
BSN
Nurse Auditor Resume
Headline : Seasoned Nurse Auditor with 7 years of expertise in compliance auditing and clinical documentation accuracy. Adept at identifying discrepancies and implementing process improvements that enhance charge capture and regulatory adherence. Committed to fostering collaboration among healthcare teams to elevate patient care and operational efficiency.
Skills : Time Management, Communication Skills, Team Collaboration, Audit Management, Data Analysis
Description :
Conducted compliance audits in collaboration with the hospital Compliance Officer, documenting issues within the network.
Analyzed patient claims affected by billing edits, ensuring accurate resolution of discrepancies.
Collaborated with ancillary departments to secure necessary information for accurate billing based on medical records.
Identified clinical documentation and coding issues, working with teams to implement effective resolutions.
Reviewed regulatory correspondence and adhered to guidelines to ensure compliance.
Performed audits by researching documentation, analyzing data, and recommending process enhancements.
Maintained up-to-date knowledge of regulatory requirements and compliance policies to ensure quality review standards.
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