Nurse Auditor, Revenue Integrity - (Remote)

Trinity Health•Livonia, MI

1d•$33 - $49•Remote

About The Position

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. Patients refers to patients, clients, residents, participants, customers, members. The colleague knows, understands, incorporates & demonstrates Trinity Health Mission, Values, Vision, Actions & Promise in behaviors, practices & decisions. 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. Knows, understands & incorporates basic or essential area of practice (document, coordinate, communicate) & training standards. Uses clear, effective, respectful language & communication methods / means. 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.

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.

Nice To Haves

Registered Nurse, preferred
Training or experience according to assignment area
Registered Nurse, preferred.
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.
Working knowledge of Electronic Health Records (EHR), preferred

Responsibilities

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.
Knows, understands & incorporates basic or essential area of practice (document, coordinate, communicate) & training standards.
Uses clear, effective, respectful language & communication methods / means.
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.
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.
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.