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Please tell me about your role as nurse auditor

Quality Improvement   (62,564 Views 13 Comments)
by Genista Genista (Member)

Genista works as a Registered Nurse.

3 Likes; 12,761 Visitors; 811 Posts

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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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Mommy TeleRN has 3 years experience and works as a Registered Nurse.

5,233 Visitors; 649 Posts

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!

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1,993 Visitors; 30 Posts

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.

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5,685 Visitors; 121 Posts

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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1,993 Visitors; 30 Posts

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.

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1,322 Visitors; 8 Posts

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/AAMAS/Files/2010/2010AAMASSalarySurvey.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

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6,253 Visitors; 105 Posts

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.

:):up:

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7,674 Visitors; 287 Posts

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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onthemend has 20 years experience and works as a SSDI.

1,688 Visitors; 3 Posts

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.

Edited by onthemend
miss spell

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onthemend has 20 years experience and works as a SSDI.

1,688 Visitors; 3 Posts

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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E-commerce has 1 years experience.

1 Like; 27,665 Visitors; 1,595 Posts

Can you intern in chart auditing? My goal is to become a Lvn and work at home as a case manager. The reason I ask is because I'm a nurse student and at my current job, spoke with my DON about doing extra work around the hospital. She had mentioned chart auditing so when the State comes, we will be well organized and I delcined. Now that I know more research about chart auditing and how it relates to case management, I would like to take up on her offer. I look forward to hearing you all responses. Thank you.

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One RN has 29 years experience.

718 Visitors; 10 Posts

If you and your pals, Genista, ever check back here & for all the newbies: the link below will take you to a very good place to obtain certification in Coding, ICD-10 and AUDITING! You can do this online and the trainer offers live classroom instruction which is the BEST!

RN-Coder | Diamond Bar, CA

Edited by One RN

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