What are the responsibilities and job description for the Quality Assurance Nurse Auditor / Nurse Analyst / Coding Auditor position at PYA P C?
POSITION DESCRIPTION
PYA is seeking a Quality Assurance Nurse Auditor/Nurse Analyst/Coding Auditor to join its high-performing and privately-owned firm with a dynamic culture and a strong national reputation. This individual will be a member of the Revenue and Compliance Advisory Team. For more information about PYA, please visit: www.pyapc.com
RESPONSIBILITIES
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Provide advisory services to ambulatory care, acute care, and post-acute care organizations, including documentation review and improvement for:
- Medical Necessity
- Level of Care
- Appropriateness of service and service location
- Billing documentation requirements and analysis of UB-04, Remittance Advices and Itemized Bills
- Assist with coding compliance reviews including professional, hospital outpatient, and inpatient hospital services
- Assist with regulatory compliance for Medicare, Medicaid, and third-party payers to include ambulatory, acute care (inpatient and outpatient), rehabilitation, and behavioral health services
- Perform research and interpret applicability of National Coverage Determination and Local Coverage Determination
- Work in collaboration with the PYA executive team and other service lines to offer complete business solutions to clients
- Manage the preparation of excellent client deliverables and exhibit exceptional project management skills while balancing firm risk and compliance with appropriate professional standards
QUALIFICATIONS
- Active LPN or RN license
- CPC, COC, CCS, or CCS-P required
- 5 years of experience in acute care medical necessity review, nurse analyst, clinical documentation improvement (CDI), and/or utilization review (UR)
- Adept knowledge in McKesson InterQual and/or Milliman, Microsoft Office Suite and working knowledge of Medicare A&B
- Excellent written and oral communication skills
- Creative-problem solver with a high level of strategic, analytical, and conceptual skills with a passion for helping clients
- Demonstrated ability in project management
ABOUT PYA
PYA is an independently owned, nationally recognized professional services firm with more than 40 years of service in accounting, tax, audit, and healthcare management consulting. Listed among the top CPA firms in the nation by USA Today, Forbes, and INSIDE Public Accounting, PYA also consistently ranks as one of the country’s Top 20 healthcare consulting firms by Modern Healthcare, is a Top 15 auditor of the nation’s largest health systems and is an industry leader in the percentage of female ownership. Learn more about The PYA Way.
