A compliance nurse can be referred to as a nurse auditor or compliance auditor. These occupations oversee patient accounting, insurance claims and insurance company audits.
Educational requirements include a bachelor's degree in nursing. Some employers require a current nursing license but are willing to accept several years of compliance experience in place of a nursing license.
Due to the complexity of insurance claims, previous experience of hospital claims audits, denials and appeals is required. Previous case management experience may be acceptable as well.
These employees perform billing audits to ensure compliance with all regulatory and organizational policies and procedures. Formulating, tracking and responding to records requests by auditing agencies in a timely manner is also required.
Compliance Maintenance Responsibilities
Overseeing compliance includes maintaining request and response databases, as well as tracking trends in compliance reporting. Statistics are reported to upper-level management for review.
In November 2009, Indeed.com lists the average salary for compliance auditing at $61,000 per year.
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