Revenue Integrity Nurse Auditor

Trinity Health • Livonia, MI

1d • $32 - $48 • 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. Our Trinity Health Culture: Knows, understands, incorporates & demonstrates our Trinity Health Mission, Values, Vision, Actions & Promise in behaviors, practices & decisions. Work Focus: 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. Process Focus: Knows, understands & incorporates basic or essential area of practice (document, coordinate, communicate) & training standards. Communication: Uses clear, effective, respectful language & communication methods / means. Environment: 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. Functional Role (not inclusive of titles or advancement career progression) NS IV – licensed: Licensed role (direct or indirect healthcare); 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.

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

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED