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
• Influences the responsible use of resources; Accountable for continuous self-development & supporting the growth of others
• Advocates for patients & informs / counsels patients & families about illness & care details
• Responsible for coordinating revenue integrity/ charge-related denials with Patient Business Service (PBS) center & ensures compliant & complete clinical documentation

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
• Knowledge of & 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

Benefits

• Health insurance
• Retirement plans
• Paid time off