Nurse Auditor, Revenue Integrity - (Remote)

Trinity Health•Livonia, MI

17d•$33 - $49•Remote

About The Position

This remote Nurse Auditor, Revenue Integrity role is a Nursing Support (NS) IV licensed position. The colleague provides clinical knowledge and nursing interventions in decision-making and participates in planning, implementing, and evaluating care-related solutions. The role performs delegated care autonomously within the applicable license and care plan, works with an interdisciplinary team, and may serve as a clinical resource, role model, mentor, or coordinator. The position is focused on revenue integrity and charge-related denials, supporting compliant and complete clinical documentation and identifying opportunities for revenue optimization. The role coordinates revenue integrity and charge-related denials with the Patient Business Service (PBS) center. It conducts routine chart and retrospective charge reviews, assists with denials and third-party charge audits, educates clinical colleagues, tracks trends and audits, and collaborates with Revenue Integrity, PBS, and departmental colleagues on education, reporting, and denial-prevention improvements. The position serves as a resource for clinical information requested by internal and external colleagues and payers. Travel between locations within the region may be required. The colleague is expected to uphold Trinity Health’s mission, values, vision, actions, and promise; follow applicable laws, regulations, policies, procedures, and the Code of Conduct; communicate clearly and respectfully; and work safely while using resources responsibly. The posted pay range is $32.5171–$48.7757.

Requirements

High school diploma or GED.
Completion of an accredited program associated with the applicable license.
License in the applicable state(s) of engagement.
Four or more years of nursing experience.
Demonstrated knowledge of revenue cycle and denial management functions.
Knowledge of and experience in case management and utilization management.
Customer service background.
Valid driver’s license where required by assignment.

Nice To Haves

Registered Nurse.
Training or experience related to the assignment area.
Bachelor’s degree.
Two or more years of charge audit, managed care, or comparable patient payment processing experience.
AAPC, AHIMA, or CHRI certification or membership.
Outpatient CDI experience.
Working knowledge of Electronic Health Records (EHR).

Responsibilities

Coordinate revenue integrity and charge-related denials with the Patient Business Service (PBS) center.
Help ensure clinical documentation is compliant and complete, assist with denials and related audits, and identify revenue optimization opportunities.
Perform thorough and routine chart reviews, educate clinical colleagues, and track identified trends.
Use clinical knowledge and standard procedures to address charge-related trends promptly and provide education to the responsible party.
Conduct retrospective charge reviews and assist with third-party charge audits.
Track Revenue Integrity-related audits, identify trends, and collaborate with Revenue Integrity, PBS, and departmental colleagues on education and reporting to key stakeholders.
Serve as a resource contact by providing clinical information requested by internal and external colleagues and payers.
Collaborate with the Revenue Integrity team to improve and implement front-end processes that support denial prevention.
Demonstrate Trinity Health’s mission, values, vision, actions, and promise in work behaviors and decisions.
Follow applicable laws, regulations, policies, procedures, guidelines, and safe work practices.