RN- Denials/Charge Audits, Full Time, First Shift

UC Health•Cincinnati, OH

About The Position

At UC Health, the RN - Denials/Charge Audits role supports data analysis, data mining, quality monitoring, and improvements in quality of care, service levels, revenue realization, and cost effectiveness. The position works under the supervision of the Director of Quality Management and Informatics. The role reviews patient records for completion of TJC core measure cases and monitors quality outcomes using population-specific clinical databases and established indicators. It enters data into the Midas system and applicable databases, prepares reports and documentation, and transmits data to appropriate registries. The RN identifies service or treatment delays and opportunities for improvement, helps develop performance-improvement strategies, participates in improvement teams and hospital PI committees, and serves as a resource on project-specific quality information and trends. The position also includes clinical responsibilities involving patient- and family-focused communication, assessment, treatment, and safe care.

Requirements

Associate degree in nursing (RN) required; a nursing diploma is also listed as a minimum qualification.
Registered Nurse license and certification required.
1–2 years of equivalent experience required.
Experience using insurance platforms or portals such as Availity, UHC/Optum, and PNM (Ohio Medicaid).
Remote work environment experience.
Epic knowledge and experience are required.

Nice To Haves

Bachelor’s degree in nursing (RN).
3–5 years of equivalent experience.

Responsibilities

Engage in population-appropriate communication and provide clear treatment instructions to patients and families.
Consider growth and development milestones, involve family or guardians in assessment and continuing care, and identify physical limitations and appropriate interventions.
Recognize and respond appropriately to behavioral health concerns, abuse or neglect, and needs related to psychological, religious, or cultural factors.
Perform treatments, administer medication, and operate equipment safely.
Review patient records for completion of TJC core measure cases; enter data into Midas; and prepare reports and documentation to improve care processes.
Work with hospital PI committees responsible for improving care processes.
Review records to monitor quality outcomes using population-specific clinical databases and established indicators; enter utilization and quality data and routinely transmit data to appropriate registries.
Identify actual and potential delays in service or treatment and opportunities for improvement, and refer them to appropriate multidisciplinary patient-care team members.
Receive comparative registry reports and handle necessary registry correspondence and communication.
Identify data to collect and assist in developing performance-improvement strategies, including those addressing complications and adverse outcomes.
Participate in project process-improvement teams and organization-wide activities coordinating data analysis efforts.
Serve as a consistent resource on project-specific quality information and trends, and maintain knowledge of current developments in the field.