Revenue Integrity Charge Auditor

Intermountain Health•Lake Park, IA

5d•$41 - $62

About The Position

The Revenue Integrity RN Charge/Coding Auditor consults on clinical charge audits for Intermountain Health. The auditor reviews medical records for Intermountain hospitals and clinics for denial reviews, defense audits, disallowed charges, and retrospective reviews, and serves as a clinical resource for Revenue Cycle departments. The role requires knowledge of laws, rules, regulations, hospital charging and coding, clinical quality, and clinical policy guidelines to support compliance and protect information. The auditor actively manages, maintains, and communicates denial activity to stakeholders throughout the denial process, including medical review boards and court proceedings. The position uses evidence-based utilization review criteria and supporting documentation to assess audits and appeals, collaborates with multidisciplinary stakeholders, identifies denial root causes, and provides subject-matter expertise and guidance to clinical and ancillary departments. It also involves ongoing education to maintain licensure and certifications. The position is located at the Lake Park Building in West Valley City, Utah, with 40 scheduled hours per week. The hourly pay range is $41.20–$62.17, dependent on experience.

Requirements

Graduate of an accredited school of nursing.
Bachelor of Science in Nursing (BSN) from an accredited institution.
Current registered nurse licensure.
Current coding certification through AAPC or AHIMA.
Experience with Microsoft Office, electronic medical record systems, and electronic databases.
In-depth knowledge of the healthcare claim denial process.
Clear understanding of the healthcare revenue cycle.
Skills in collaboration, problem solving, critical thinking, attention to detail, sound clinical judgment, effective written and oral communication, patient and hospital advocacy, computer literacy, efficiency, and results focus.

Nice To Haves

Master of Science in Nursing (MSN) from an accredited institution.
EPIC experience.
Clinical experience in hospital care settings or previous auditing experience.
Experience in utilization review and/or case management, hospital insurance billing, third-party claim or charging audits, or auditing in a healthcare setting.

Responsibilities

Use nationally recognized evidence-based utilization review criteria, such as Milliman Care Guidelines (MCG) or InterQual, to determine viability for commercial and governmental insurance audits using supporting documentation.
Assess the appropriateness of clinical appeal requests by identifying and analyzing payer policies and Federal and State regulations.
Collaborate with multidisciplinary stakeholders during the audit process.
Identify and communicate denial root causes with members of the healthcare team.
Serve as a subject matter expert on hospital charging, documentation requirements, clinical disease processes and treatment, and medical necessity decisions.
Support ancillary clinical-based departments with audit-related research and analysis of regulatory information.
Provide guidance on policy and procedure development, training and support, and applicable clinical education focused on reducing clinical denials.
Develop and maintain understanding of projects and assigned functions, including relevant technology, products, organizational activities, and systems.
Complete ongoing education and CEU requirements to maintain licensure and certifications.
Manage, maintain, and communicate denial activity to stakeholders throughout the denial process, including medical review boards and court proceedings.