Registered Nurse (RN) Revenue Cycle Nurse Auditor (FT M-F 8-5)

UMC Health System•Richmond, KY

19h•Onsite

About The Position

The Revenue Integrity Clinical Nurse Auditor leverages clinical knowledge and documentation review to ensure appropriate charge capture and revenue optimization. Responsibilities include leveraging Epic technology and analytics to identify revenue integrity trends and investigate areas of revenue leakage, monitor financial performance and work with IT to build mistake-proofing into the Epic system. The nurse auditor will work with clinical teams, compliance and other departments within revenue cycle to provide documentation and charging education and maximize system efficiency, timely and complete charge capture, and submission of clean claims to payer to drive financial performance.

Requirements

Bachelor’s degree in nursing from an accredited college or university
5+ years of experience in utilization review, clinical review, and authorizations
Knowledge of CMS Medicare Part A, B, & C billing requirements
Advanced experience with national evidence-based screening guidelines (MCG, formerly Milliman Care Guidelines)
Valid Texas RN License/Eligible Compact License
Well-versed in ICD10 diagnosis codes and payer regulations
Expert level analytical and process mapping skills
High level knowledge of Medicare, managed care, and commercial insurance payment requirements
Excellent attention to detail, communication and reporting skills
Highly organized with the ability to multi-task and prioritize work
Self-starter with the ability to think outside-the-box to solve problems
Customer service focus, critical thinker, and excellent interpersonal skills

Nice To Haves

Viseo software experienced user, is preferred

Responsibilities

Responsible for identifying, building, and maintaining revenue guardian edits within the Epic billing system based on documentation and CDM requirements.
Perform routine chart audits and clinical documentation review to identify correct level of care, missing, incorrect or undocumented charges across clinic, hospital and ancillary departments.
Provide education to clinical and professional staff regarding proper documentation to ensure accurate patient charging.
Work with clinical, financial, and operational stakeholders to implement accurate and complete charging for new and emerging therapies and services and high-risk/high-dollar services provided by the organization.
Facilitate the review and response to CMS Medicare RAC Audits along with other payer and outside agency audits involving hospital billing.
Finalize and sign-off with those auditors on agreed upon final audit reports and charges.
Utilize clinical knowledge and documentation review to identify revenue guardian edits within the billing system and perform routine chart audits.
Collaborate with clinical teams and other departments to provide documentation and charging education, maximize system efficiency, and ensure timely and complete charge capture.
Monitor KPIs such as missing and late charges, charge lag timeframes, average daily revenue, ABN completion, DNFB days/days to timely bill, and clinically triggered charges. Also, follow up on improvement initiatives with departments negatively impacting metrics.
Monitor denial trends related to upstream system and logic issues and/or workflows and act as a liaison across departments to find solutions.
Align with CDI, Coding and CBO/Revenue Cycle follow-ups teams to reduce denials and influence proactive revenue optimization.
Work effectively with ancillary departments, IT, physicians, clinics, and all other hospital clinical areas to resolve charge capture and process gaps.
Develop and update policies related to billing and revenue and perform clinical investigations of potential claim payment integrity issues.
The nurse auditor will facilitate drafting appeal letters and identify denial trend root causes.