Illinois Licensed Nurse Auditor

To maximize client savings, the full-time Illinois Licensed Nurse Auditor will remotely review medical bills, ensuring appropriate billing, coding, and treatment while maintaining compliance with fee schedules and identifying erroneous charges. Key responsibilities Audit medical and billing records to assess the reasonableness and necessity of services provided Clinically identify and evaluate charges unrelated to the occurrence and verify compliance with authorized services Initiate contacts with clients and medical providers as necessary and negotiate bills when required Required qualifications Active RN (or LPN) professional license or equivalent within states of operation CPC and/or CPC-H certification(s) strongly desired 3-5 years of clinical experience in acute care, surgery, and/or orthopedics Understanding of CPT and ICD-10 codes and Medicare guidelines Experience in Workers' Compensation medical bill review is a major plus