Please tell me about your role as nurse auditor

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    Hi. I posted something similar in another forum. I'm an experienced acute care RN with 12+ years experience in various depts. who is burned out on bedside nursing. I am curious about what RN auditors do. How tedious is it? Is it interesting? I am nervous about leaving "the bedside," but also very ready for a big change. What kinds of questions would you ask at an interview about such a position? Is the pay similar or much less than floor nursing? Thank you.
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    Do you know exactly what you'd be auditing in the charts?

    I just got a position away from bedside and will start in a couple weeks. My position will be pulling data from charts for core measures and various database registries. I was really worried if the pay would be comparable. I was pleasantly surprised. I have been a nurse 4 years and work float. I would have had to take a big paycut to leave float and work one department. With my new job I will make comparable to what I'd making work day float and I get a little better benefits (mainly paid time off which I don't currently get) If you think you are ready for a change go for it!
    RNJean1412 and Lytllola like this.
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    There are different types of auditors. The common thread is you look at the medical records to verify or gather info. HEDIS audit/abstraction involves looking at different types of care (diabetes, prenatal, childhood immunizations, HTN, etc.) Basically, you want to see if what kind of care was given to the patient (prescribed meds, labs that were ordered, immunizations that were given, etc). HEDIS is a method of grading the health insurance plans, so the public can make an education choice.

    Payment integrity or claims integrity is verifying that certain diagnoses and procedures matches the medical codes that were listed in the billing. complex medical codes correspond to bigger pay. Sometimes complex codes are used, but if you look at the medical records, the physician's work does not reflect complexity. You don't want overpayment or underpayment.
    VU RN BSN likes this.
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    Hello How can I get started in this field. What are some companies where I can apply. Please give me some tips and advice. Thank you. I have eight years of nursing experience. Thank you.
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    Google MedAssurant or Outcomes Health Information Solutions. Their hiring criteria is lax compared to the criteria for utilization review/case management. As long as you have clinical experience and the desire, chances are you'll get it. The downside is they do not guarantee hours, so make sure you have another part time job that can support just in case you don't get hours from reviewing charts.
    The projects are seasonal. HEDIS is from March to May, so in June and July, there may not be any work. Risk adjustment is in fall. One company pay by the hour. The other pay by the number of charts that you finish. Make sure you know the details of the employment. Many people have been happy with the duties, but disappointed with the hours, pay, and other issues.
    RNJean1412 and lifein08 like this.
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    Nurse Auditors also do claims review for over and under payment, compliance, special investigations etc. They work in various settings -- from hospitals, payor-insurance and government settings - medicare, medicaidm military, veterans etc.
    Read more on the salary survey below.
    http://www.resourcenter.net/images/A...larySurvey.pdf

    Hi. I posted something similar in another forum. I'm an experienced acute care RN with 12+ years experience in various depts. who is burned out on bedside nursing. I am curious about what RN auditors do. How tedious is it? Is it interesting? I am nervous about leaving "the bedside," but also very ready for a big change. What kinds of questions would you ask at an interview about such a position? Is the pay similar or much less than floor nursing? Thank you.

    Job opportunities:
    http://www.aamas.org/news/career-opportunities.html
    VU RN BSN likes this.
  10. 1
    Quote from green217
    There are different types of auditors. The common thread is you look at the medical records to verify or gather info.

    Payment integrity or claims integrity is verifying that certain diagnoses and procedures matches the medical codes that were listed in the billing. complex medical codes correspond to bigger pay. Sometimes complex codes are used, but if you look at the medical records, the physician's work does not reflect complexity. You don't want overpayment or underpayment.
    This is the type of work I do now. I'm employed by an insurance company, and my job is in their Work Comp division. I enjoy it! This is the first job I have ever actually liked since graduating from nursing school over 7 years ago! I find a lot of it quite fascinating.

    I use CPT books, Hick-Picks, CCI, and various other Coder's Reference books to do my job. I review medical bills and documentation on Work Comp cases. I work on a computer, in an office, at my cubicle. It is very nice.

    Feleshiaj likes this.
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    oh, how I long to work in an office, in a cubicle!!! I've been wanting to get away from the bedside for a while!!!

    Thank you everyone who replied in this thread! I already learned A LOT going to the AAMAS website, and look forward to checking out the other ones listed.
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    I worked in Labor and delivery for 10 years. Firm believer in teamwork. Unfortunately, I hurt my back many years ago during a delivery. I recovered in a couple days, and back to work I went. Several years later I worked in 'Quality Improvement' and then 'Risk Management'.
    Three years later, I was so traumatized by what I learned and witnessed, I had to leave the profession. Am on disability due to health issues and I am 43. I miss Labor so much, but am so afraid to run to the emergency, like I used to. HELP. Or warning.MD peer review was all for show--the last two hospitals I worked.
    Last edit by onthemend on Oct 25, '11 : Reason: miss spell
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    Morning...have so much to say but I have to be HIPPA careful. I have been RN for 21 years. BSN, and some MSN.
    I worked ED M/S. Last 10 years were labor. Then for the hours of 8-5, I took a job in Quality Improvement and the Risk Mgr.
    I was so horrified at what I saw. I even went to state and federal agencies after I was 'fired' for reporting an 'incident'. Nobody 'did' anything.
    I started another job in Labor but was terrified to run to emergencies...because of QA. I joke with friends about being the only nurse who came out of QA with PTSD.
    Consequently, I went on disability due to the above and health problems: back, carpal tunnel and then some.
    Anyone out there that can help I sure would appreciate it.


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