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Responsible for working/editing daily assigned claims, optimizing timely transmittal of accurate and clean claims. The nurse auditor/analyst is responsible for identifying and obtaining invalid/missing claim data by communicating with other departments to secure and/or correct the data which prevents claim submission. Protects payer deadline by utilizing all available resources to resolve held claims and assures all known regulatory and compliance guidelines are adhered to. Assist the Manager in managing the team’s daily and monthly activities. Assist in resolving team’s issues and achieving quality service/support for assigned facilities.


  • Analyze and resolve patient claims being held by billing edits.
  • Review the APC Grouper, Ancillary, Overlap and Rapid Response reports/worklist daily for timely resolution of billing edits.
  • Acts as a liaison and interacts with departments to obtain information needed to properly bill accounts based on the documentation in the medical record.
  • Prepares and reviews work comp implant invoices to ensure accurate billing.
  • Assist with late charge action plan templates. Assists with staff communication, providing updates, resolving issues, setting goals and maintaining standards.
  • Perform quality reviews of the team members’ deliverables.
  • Assist in the development of standardized tools, resources and policies, and procedures.
  • Conduct orientation and training for new hires within the team


  • Understanding of all required fields on the UB-04, correct coding initiative, revenue codes, DRG guidelines, ICD 9/10, CPTs and HCPCs, modifiers, condition codes
  • Strong working knowledge of third-party billing requirements to include Medicare, Medicaid, Commercial and Managed Care payers.
  • Knowledge of CPT4 and HCPCS 3-5 years prior experience in billing of claims

Skills Requirement:

  • Administration
  • Clinical Information Systems
  • Medical Records


  • Miscellaneous allowance, Medical, Business (e.g. Shirts), Night Shift
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