Quality Assurance Nurse Auditor / Nurse Analyst / Coding Auditor

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.

RESPONSIBILITIES

• Provide advisory services to ambulatory care, acute care, and post-acute care organizations, including documentation review and improvement for:
  1. Medical Necessity
  2. Level of Care
  3. Appropriateness of service and service location
  4. 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

• 5+ years of experience in acute care medical necessity review, nurse analyst, clinical documentation improvement (CDI), and/or utilization review (UR)
• CPC, COC, CCS, or CCS-P required
• Active LPN or RN license
• 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, a leading professional services firm, serves clients across the United States with expertise in healthcare consulting, accounting, compliance, and business strategy. With offices in Knoxville, Atlanta, Tampa, Charlotte, Nashville, and Kansas City, PYA is committed to helping clients achieve their goals through innovative solutions and unparalleled service. Learn more about The PYA Way.

Why Join PYA?

• Be part of a dynamic and collaborative team that values innovation and excellence
• Work with industry leaders who are committed to professional growth and client success
• Competitive compensation, comprehensive benefits, and opportunities for career advancement