Ensure proper patient care, accurate medical records and policy compliance.
What does a Nurse Auditor do?
If you’re a Nurse Auditor, then chances are you’re detail-oriented, analytical, and self-motivated. You have to be. That’s because, in addition to performing the duties of a Certified Registered Nurse, as a Nurse Auditor, you take on auditing responsibilities, too. You check and recheck patient files to make sure every t is crossed and every i is dotted.
You aren’t really looking for spelling or grammar errors in that mountain of paperwork when you’re a Nurse Auditor. Rather, you focus on the accuracy of the content. You make sure that every person who touched the file left an accurate record of the patient’s care. Doctors, Nurses, and office staff all contribute to the details of a medical file, so if it’s missing a signature, a date, or a billing code, you track it down.
Speaking of billing, that’s how the clinic, hospital, or Doctor gets paid, so it had better be right! If an insurance plan doesn’t cover mental health, and the code for a mental health exam is entered instead of, say, the code for an ear infection, that file can be tied up on the insurance billing treadmill for a long, long time.
In addition to limiting billing problems, you also make sure that the files comply with governmental policies. Fines, penalties, and even closure can result if a government Agent reviewing the file finds fraud, mistakes, or omissions. That’s a lot of responsibility. And remember, being a Nurse Auditor is just a bonus round while you also fulfill your regular nursing duties!