Nurse Manager, Revenue Integrity

BHS

26d • Remote

About The Position

Baptist Health is looking for a Nurse Manager, Revenue Integrity to join our team! This is a remote position that requires residency in KY or IN Supports day-to-day operations for Authorizations and Denials Management, providing direct support to team members when needed. This role is responsible for integrating clinical expertise with payer policy, regulatory requirements, and revenue cycle operations to prevent patient access delays due to pending authorizations, reduce preventable denials, optimize reimbursement, and ensure compliant billing practices. Collaborates with the Director to lead the development, implementation and maintenance of standardized policies, procedures and strategies including authorization workflows, collaborating with Physicians, Mid-level providers and office staff for both denials prevention and authorizations, managing work queues, reviewing payer policies, and providing clinical support. Serves as a system expert in Authorizations and Denials Management. If you would like to be part of a growing family focused on supporting clinical excellence, teamwork and innovation, we urge you to apply now! Baptist Health is an Equal Employment Opportunity employer. Founded in 1924 in Louisville, Kentucky, Baptist Health is a full-spectrum health system dedicated to improving the health of the communities it serves. The Baptist Health family consists of 10 hospitals, employed and independent physicians, and more than 470 points of care, including outpatient facilities, physician practices and services, urgent care clinics, outpatient diagnostic and surgery centers, home care, fitness centers, and occupational medicine and physical therapy clinics. Baptist Health’s eight owned hospitals include more than 2,300 licensed beds in Corbin, Elizabethtown, La Grange, Lexington, Louisville, Paducah, Richmond and New Albany, Indiana. Baptist Health also operates two joint venture hospitals: the 410-bed Baptist Health Deaconess Madisonville in Madisonville, Kentucky with Deaconess Health System based in Evansville, Indiana, and the Baptist Health Rehabilitation Hospital, a 40-bed inpatient rehabilitation facility with Encompass Health, based in Birmingham, Alabama. Baptist Health employs more than 24,000 people in Kentucky and surrounding states. Baptist Health is the first health system in the U.S. to have all of its hospitals recognized by the American Nursing Credentialing Center with either a Magnet® or Pathway to Excellence® designation for nursing excellence. Baptist Health’s employed provider network, Baptist Health Medical Group, has more than 1,820 employed providers offering care in 78 specialties, including approximately 862 physicians and 958 advanced practice clinicians. Baptist Health’s physician network also includes more than 2,000 independent physicians. EEO Statement: Baptist Health is an Equal Employment Opportunity employer, and seeks to employ individuals without regard to race, color, national origin, gender, sexual orientation, gender identity, age, disability, marital status, citizenship status, military status, religious or political beliefs, protected veteran status, employment status or any other protected class identified in any federal, state, or local law. Baptist Health specifically encourages minority, female, disabled, veteran and other candidates from diverse backgrounds to apply and strengthen our team. Please note that Baptist Health is a drug-free workplace and employment with Baptist Health is subject to post offer, pre-employment drug testing. NOTICE OF NONDISCRIMINATION AND ACCESSIBILITY TO SERVICES Persons with hearing and speech impairments can contact Baptist Health facilities by using the Kentucky Relay Service, a toll-free telecommunication device for the deaf (TDD). For voice to TDD, call 800.648.6057. For TDD to voice, call 800.648.6056.

Requirements

• BSN with minimum 3 years of revenue cycle experience is required.
• In lieu of a bachelor’s degree, associate’s degree with five years management/supervisory/team leader experience in revenue cycle related position.
• Requires knowledge of medical terminology and a basic understanding of coding and payment methodologies including DRG and APC.
• Individuals working with payor audits must have a keen understanding of all audit response requirements and timelines.
• Valid Kentucky Licensure as a Registered Nurse

Responsibilities

• Solves problems and serves as a resource throughout the system on authorizations and denials management subject matter to promote compliance between documentation and payor coverage guidelines.
• Constantly collaborates with staff to seek more efficient methods for completing tasks.
• Identifies process improvement opportunities and develops plans to implement process improvement in collaboration with Managers, Director, or AVP.
• Communicates process improvement plans with staff and facilitates implementation.
• Listens to the needs and concerns of corporate and local leadership regarding specific needs in their markets and supports the leadership team in developing an appropriate plan to respond considering the overall organization and all its departments.
• Collaborates with other departments and physician offices as necessary to prevent revenue loss, both in a reactive response to authorizations / denials / underpayments / payer audits as well as in a proactive response to changes in payor / governmental authorization and coverage guidelines.
• Informs hospital departments (Scheduling, Registration, Case Management, etc.) of denials that resulted from process breakdowns in collaboration with Director and AVP in an effort to prevent future denials.
• Assists Director with improvement upon current provider documentation practices to be used for coding and payer coverage guidelines.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager