Nurse Auditor, Revenue Integrity
Job Description:
- 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
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