The position of a nurse auditor is ideal for those who are interested in both nursing and business and a step up the career ladder in the world of registered nurses. Nurse auditors are generally responsible for inspecting medical records and analyzing accounting sheets in hospitals to verify their accuracy.
To become a nurse auditor, one must first become a licensed, registered nurse. This is accomplished by studying nursing in an accredited school or college and earning at least an associate’s degree in nursing – although a bachelor’s degree is more advantageous – and then passing state licensing board tests. Nurse auditor positions are rarely entry-level, so most work their way to the position after gaining meaningful experience in a hospital or checking and verifying medical records in a similar position.
Nurse auditors can expect to work in a medical clinic or hospital, although on occasion they are also employed by insurance or pharmaceutical companies. In most circumstances, they can expect to be indoors in an office and throughout the medical facility as needed. Most work 40-hour weeks, and travel may occasionally be required.
Analytical thinking and attention to detail are crucial in this position, given the focus on reviewing medical records and financial statements, and knowledge of accounting is also important. It can be expected that multiple projects will be handled at once, so multi-tasking abilities are necessary whether working alone or as a team member. Nurse auditors can expect to routinely interact with other health care professionals, generally pertaining to coding and conducting billing and auditing, as well as verifying that charges are backed up by clinical records before writing reports. They must also be aware and up-to-date regarding all governmental policies and laws relevant to the health care industry.
Nurse Auditor Tasks
Review and audit billing, reimbursements and internal documentation to ensure adherence to technical guidelines.
Performs audits to identify and resolve discrepancies on paid care accounts, patient billing accounts and other government accounts.
Protect the hospital’s financial interests by reviewing third party charges, grievances and other billing issues.
Serve as clinical and financial consultant to patient accounts and hospital departments.