Revenue Utilization Review Nurse

United States Department of Veterans Affairs • Orlando, FL

371d • Onsite

About The Position

The Florida Caribbean Consolidated Patient Accounts Center (FCCPAC) is seeking a Registered Nurse (RN) to enhance revenue operations within the Veterans Health Administration (VHA) network. This role focuses on providing clinical information to third-party payers, ensuring compliance with reimbursement criteria, and managing clinical denials. The RN will collaborate with various stakeholders to improve revenue cycle processes and participate in performance improvement initiatives.

Requirements

• Proficiency in basic written and spoken English.
• Graduate of a school of professional nursing accredited by ACEN or CCNE.
• Current, full, active, and unrestricted registration as a graduate professional nurse in a U.S. State, Territory, or Commonwealth.
• For foreign nursing graduates, possession of a current, full, active, and unrestricted registration is required.

Nice To Haves

• Strong clinical background with 3-4 years of nursing experience.
• 1-3 years of relevant case management or utilization review experience.
• InterQual experience preferred.
• Case Management or Utilization Review certification preferred.
• Knowledge and skills in applying CPT, ICD 10, and HCPCS coding.

Responsibilities

• Serve as a patient advocate providing accurate and timely clinical information to third-party payers.
• Ensure compliance with established third-party payer criteria for reimbursement and appeal of clinical denials.
• Conduct precertification with third-party payers including VA and Community Care as applicable.
• Validate Service Connection (SC)/Special Authority (SA) relatedness for revenue cases.
• Manage clinical denials for revenue.
• Perform legal case relatedness review for revenue billing purposes.
• Provide education to VA medical facility providers and other staff on revenue-related topics.
• Collaborate with CPAC and VA medical facility staff on revenue cycle tasks.
• Collect, analyze, and report data related to revenue cycle management.
• Participate on CPAC and/or facility committees, workgroups, and performance improvement projects.

Benefits

• Competitive salary with regular salary increases and potential for performance awards.
• 50 days of paid time off per year (26 days of annual leave, 13 days of sick leave, 11 paid Federal holidays).
• Traditional federal pension with 5 years vesting and federal 401K with up to 5% contributions by VA.
• Federal health, vision, dental, term life, and long-term care insurance options.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Administration of Human Resource Programs
• Education Level: Associate degree