Nurse Auditor, Revenue Integrity

Role Overview

• Provides safe, quality health care services & / or assistance to patients under the supervision & direction of a registered nurse or other designated health care professional
• 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
• Communicates effectively and respectfully
• Performs work in a safe, engaging, & supportive manner
• Maintains knowledge of applicable federal, state & local laws
• Performs nursing interventions or clinical knowledge application in decision-making
• May administer medication & carry out therapeutic treatment within scope of license
• Advocates for patients & informs patients and families about care details
• Collaborates with Revenue Integrity team on opportunities to improve & implement front-end process to support denial prevention

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
• 4+ years of nursing experience
• Demonstrated knowledge of revenue cycle & denial management functions
• Experience in case management & utilization management
• Customer service background is required
• Registered Nurse, preferred
• Bachelor’s degree, preferred
• 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