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RN/LNP Nurse Auditor

The primary role of a nurse auditor is to ensure the quality of care provided to patients matches the medical facility’s documentation. This involves reviewing medical records pertaining to the needs of the patient, the care administered, and insurance coverage of the patient to make sure everything complies with legal healthcare requirements as well as facility standards. For a person to succeed as a nurse auditor, they must have extensive knowledge of medical procedures and healthcare practices as well as a proficiency with health insurance, billing, and medical coding.

Qualifications

  • Nursing degree or related healthcare field experience required
  • Current RN or LNP license in the state you plan to work in
  • At least 3 years of auditing/quality assurance experience in the healthcare field highly preferred
  • Any other degrees, experience, certifications involving information management, finance, accounting, or data analysis is a plus
  • Ability to use data management software
  • High attention to detail
  • Proclivity for problem-solving
  • Strong verbal communication skills with other RNs/LNPs, medical facility management, and clients

Responsibilities

  • Auditing medical charts, billing documents, insurance forms
  • Making sure care given was appropriate and noted with the right medical code
  • Documenting results of reviews and audits to validate the reasons for medical treatment
  • Participating in quality assurance initiatives in the facility
  • Assuring coding and billing compliance
  • Ensuring that all activities including audits, documentation, and data storage comply with facility policies
  • Performing tasks given by facility management or Lead Auditor