Nurse Auditor

Responsibilities

One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500 corporation, annual revenues were $14.3 billion in 2023. During the year, UHS was again recognized as one of the World's Most Admired Companies by Fortune; and listed in Forbes ranking of America's Largest Public Companies.

Headquartered in King of Prussia, PA, UHS has approximately 96,700 employees and continues to grow through its subsidiaries. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related

services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom.

Atlantic Region CBO (uhs.com)

The Atlantic Region CBO is seeking a dynamic and talented Nurse Auditor with clinical case management experience to be responsible for the resolution of billing edits, coordination and completion of billing audits, education of business office and facility staff related to charging and billing issues and the review of denial trends and high charge stays for billing accuracy.

Key Responsibilities include :

• Perform clinical reviews in response to claim denials by third party payers.
• Analyze medical records to confirm medical necessity as it pertains to inpatient level of care, readmissions, patient length of stay, non-covered services, experimental and investigational issues, ER Downgrades, DRG validation and other claim denials.
• Draft detailed clinical appeal letters to submit to third party payers to obtain reimbursement for denied claims.
• Make decisions to downgrade inpatient claims to observation status and perform calculation of observation hours.
• Call third party payers and physician offices as needed to obtain additional clinical details, retro-authorization requests, and clarity on denials.
• Identify denial trends and provide feedback to management and to UHS acute care facilities.
• Adheres to all applicable laws, regulations and guidelines
• Other duties as assigned.

Benefit Highlights

Contact Information :

Qualifications

Position Requirements :

Disclaimer

The Atlantic Region CBO is not accepting unsolicited assistance from search firms for this employment opportunity. Please, no phone calls or emails. All resumes submitted by search firms to any employee at UHS via-email, the Internet or in any form and / or method without a valid written search agreement in place for this position will be deemed the sole property of UHS. No fee will be paid in the event the candidate is hired by UHS as a result of the referral or through other means.

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.

Avoid and Report Recruitment Scams

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.

If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.