Nurse Auditor Revenue Integrity (Remote)
About The Position
Purpose Work Remote Position (Pay Range: $36.8795-$47.8193) The Nursing Support (NS) colleague (uncertified, certified, unlicensed, or licensed) provides safe, quality health care services & / or assistance to patients under the supervision & direction of a registered nurse or other designated health care professional in accordance with level of experience, education, policies & procedures. Note: “patients” refers to patients, clients, residents, participants, customers, members Essential Functions Our Trinity Health Culture: Knows, understands, incorporates & demonstrates our Trinity Health Mission, Values, Vision, Actions & Promise in behaviors, practices & decisions. Work Focus: Performs clinical care activities (direct or indirect) for patients within the “scope of practice” laws & training received; Cares for patients safely by assisting in clinical care services or engaging in administrative activities (e.g., maintaining records or supplies) that enhance or improve coordination, preparation & flow of the care experience. Process Focus: Knows, understands & incorporates basic or essential area of practice (document, coordinate, communicate) & training standards. Communication: Uses clear, effective, respectful language & communication methods / means. Environment: Performs work in a safe, engaging, & supportive manner; Influences the responsible use of resources; Accountable for continuous self-development & supporting the growth of others. Maintains a working knowledge of applicable federal, state & local laws/regulations, Trinity Health Integrity & Compliance Program & Code of Conduct, as well as other policies, procedures & guidelines in order to ensure adherence in a manner that reflects honest, ethical & professional behavior & safe work practices. Functional Role (not inclusive of titles or advancement career progression) NS IV – licensed: Licensed role (direct or indirect healthcare); Provides nursing interventions or clinical knowledge application in decision-making; Participates in the planning, implementation & / or evaluation of & solutions for care; Performs delegated focused / holistic care autonomously according to care plan; May administer medication & carry out the therapeutic treatment within scope of license (state & TH policy); Performs direct & essential care or supportive activities as part of an interdisciplinary team with a deeper understanding, including theoretical knowledge; Demonstrates a level of independence to perform activities with general oversight, through personal contributions, teamwork & initiatives to safely improve outcomes; Advocates for patients & informs / counsels patients & families about illness & care details; May serve as a knowledge resource, role model & mentor or lead / coordinate / supervise direct & essential care activities or role-based service responsibilities of unlicensed / licensed / certified healthcare professionals within licensed scope of practice.
Requirements
- High school diploma or GED
- Completion of an accredited program associated with license.
- License in the applicable state(s) of engagement.
- Valid driver’s license where required by assignment.
- Four (4) + years of nursing experience
- Must possess a demonstrated knowledge of revenue cycle & denial management functions.
- Knowledge of & experience in case management & utilization management.
- Customer service background is required.
- Working knowledge of Electronic Health Records (EHR), preferred
Nice To Haves
- Registered Nurse, preferred
- Training or experience according to assignment area
- Bachelor’s degree, preferred.
- Two (2) + years of charge audit, managed care or comparable patient payment processing experience preferred.
- AAPC, AHIMA, CHRI certification/membership strongly preferred.
- Outpatient CDI experience preferred.
Responsibilities
- Responsible for coordinating revenue integrity/ charge-related denials with Patient Business Service (PBS) center & ensures compliant & complete clinical documentation, assists with denials & related audits & identifies opportunities for revenue optimization.
- Performs thorough and routine chart reviews, providing education to clinical colleagues & tracking of identified trends.
- Leverages clinical knowledge & standard procedures to ensure timely attention to charge-related trends and provides necessary education to responsible party.
- Responsible for retrospective charge reviews & assistance with third party charge audits.
- May require travelling between locations within the region.
- Ensures tracking of all Revenue Integrity- related audits, identifying trends & collaborating with other Revenue Integrity, PBS & /or departmental colleagues on education & reporting to key stakeholders.
- Serves as a resource contact, providing clinical information as requested by intra & inter-departmental colleagues & payers.
- Collaborates with Revenue Integrity team on opportunities to improve & implement front-end process to support denial prevention.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
Number of Employees
251-500 employees
