University of Maryland Upper Chesapeake Health (UM UCH) offers the residents of northeastern Maryland an unparalleled combination of clinical expertise, leading-edge technology, and an exceptional patient experience.
A community-based, integrated, non-profit health system, our vision is to become the preferred, integrated health system creating the healthiest community in Maryland. We are dedicated to maintaining and improving the health of the people in our community through an integrated health delivery system that provides high quality care to all. Our commitment to service excellence is evident through a broad range of health care services, technologies and facilities. We work collaboratively with our community and other health organizations to serve as a resource for health promotion and education.
Today, UM UCH is the leading health care system and second largest private employer in Harford County. Our 3,500 team members and over 650 medical staff physicians serve residents of Harford County, eastern Baltimore County, and western Cecil County.

University of Maryland Upper Chesapeake Health owns and operates:
University of Maryland Harford Memorial Hospital (UM HMH), Havre de Grace, MD
University of Maryland Upper Chesapeake Medical Center (UM UCMC), Bel Air, MD
The Upper Chesapeake Health Foundation, Bel Air, MD
The Patricia D. and M. Scot Kaufman Cancer Center, Bel Air, MD
The Senator Bob Hooper House, Forest Hill, MD

Under general supervision, conducts internal audits of hospital bills working with external auditors to ensure that uncompensated patient revenues resulting from audits of patient service billings (claims) are minimal. Use the information obtained from the audit process to inform and educate UMMS personnel concerning clinical reimbursement results and practices.

All registered nurses working within UMMS shall follow the guidelines for professional practice promulgated by the Maryland State Board of Nursing. Any need for interpretation of the guidelines will be the responsibility of the UMMS Vice President or his/her designee.

• Plans work for self and with coworkers, including setting goals, prioritizing work and coordinating the execution of work. Determines work priorities and resource allocation across multiple clinical audit activities based on interpretation of data and reports.
  • Uses a systematic process to identify departmental charges.
  • Evaluates each patient medical record reviewing specific documents relating to patient treatment and billable charges, identifying services billed versus services rendered.
  • Evaluates patient medical record versus the bill, noting discrepancies in over-, under- and incorrectly billed items, correctly calculates the total dollar amounts for each discrepancy and submits necessary documents for patient account adjustment.
  • Negotiates with external auditors regarding billing issues.
  • Completes and submits audit documentation in a timely fashion.
  • Communicates regularly with UMMS clinical and administrative personnel to obtain further supportive documentation for billed services beyond that which is found in the medical record.
  • Audits predetermined amount of billing based on complexity of audit.
  • Meets with appropriate department personnel to establish methods for obtaining support documentation.

• Current active RN registration with the Maryland State Board of Nursing is required.
• Three years current clinical experience, specialty is preferred.
• Knowledge of hospital review procedures, third party payment, quality improvement and regulatory agency procedures and policies.
• Effective oral and written communication skills required to deal with insurance companies and hospital staff.
• Effective negotiating skills.
• Ability to apply clinical assessment skills to the medical record audit process and extract supportive documentation.
• Ability to apply patient care protocols (standardized; UMMS; TJC) to billing practices.
• Demonstrated ability in use of personal computer and related software. Expertise in spreadsheets, word processing and data base management packages preferred; ability to learn these skills required.
• Ability to work independently.