Revenue Integrity Nurse Auditor (Remote) id-12770
About the position
The position is responsible for coordinating denials with the Patient Business Service (PBS) center, ensuring compliant and complete clinical documentation, assisting with denials and related appeals, and identifying opportunities for revenue optimization. The role involves investigating denials, performing thorough chart reviews, providing education to clinical colleagues, and tracking identified trends to enhance revenue integrity.
Responsibilities
- Coordinate denial management processes for the Revenue Integrity department, focusing on retrospective follow-up and assisting in appeal processing.
- Ensure tracking of denials and audits, identifying trends, and collaborating with Revenue Integrity colleagues and PBS on education and reporting.
- Review and understand utilization review and coverage guidelines for multiple payers.
- Identify solutions to issues affecting reimbursement related to denial prevention.
- Serve as a resource contact, providing clinical information as requested by colleagues and payers.
- Collaborate with the Revenue Integrity team on opportunities to improve front-end processes to support denial prevention.
- Collaborate with intra-department and PBS teams on accurate documentation and reporting of key performance indicators.
- Support the development of effective internal controls that promote adherence to applicable laws and program requirements.
- Identify opportunities for process improvement and participate in implementation as needed.
- Assist in the design and development of system enhancements while monitoring congruency with process goals and regulatory mandates.
- Maintain a strong working relationship with the ministry Payer Strategy team to ensure proper identification and resolution of clinical denials.
- Provide detailed understanding of resolving denials based on patient status and constructing warranted appeals for defined populations.
- Interpret data, draw conclusions, and review findings with intra and inter-departmental teams.
- Coordinate concurrent and retrospective audits of patient medical records and itemized bills as requested.
- Keep abreast of denial trends and regulations concerning healthcare financing and payer relations.
Other Jobs You May Be Interested In
Remote Data Entry, No Experience, $40/hr, Part-TimeVirtual Assistant, $45/hr, Remote, No Experience, Night Job
Entry-Level Remote Data Entry, $50/hr, Evening Job
Customer Support, No Degree, $40/hr, Remote, Weekend Job
Remote Phone Job, $42/hr, Part-Time, College Student Friendly
Virtual Assistant, $40/hr, Remote, No Degree, Night Job
Part-Time Data Entry, $45/hr, Remote, College Student Friendly
Remote Moderator, No Degree, $50/hr, Evening, Weekend Job
Remote Customer Support, $42/hr, Night Job, No Experience
Live Chat Support, $40/hr, Remote, Entry Level, Part-Time
Virtual Assistant, Remote, $42/hr, Weekend, No Experience
Remote Data Entry, $45/hr, No Degree, Night Shift
Part-Time Customer Support, $40/hr, Remote, College Student
Remote Live Chat, $50/hr, Part-Time, Evening/Night Job
Entry Level Phone Job, $42/hr, Remote, No Degree Required
Weekend Data Entry, $45/hr, Remote, No Experience
Remote Virtual Assistant, $40/hr, Evening, Part-Time Job
Remote Moderator, $42/hr, Part-Time, Weekend, No Degree
Data Entry, $45/hr, Remote, Night Shift, College Student Job
Phone Support, Remote, $50/hr, No Experience, Part-Time
Virtual Assistant, No Experience, $42/hr, Remote, Weekend
Remote Customer Support, $45/hr, Part-Time, College Student
Data Entry, Remote, $40/hr, Night Shift, No Degree
Evening Virtual Assistant, Remote, $45/hr, No Experience
Weekend Customer Support, $42/hr, Remote, College Student
Remote Data Entry, $50/hr, No Experience, Evening/Night Job
Remote Live Chat, $40/hr, Part-Time, No Degree Required
Virtual Assistant, $42/hr, Remote, Weekend, Entry Level
Remote Phone Support, $45/hr, Evening, No Experience Required
Data Entry, No Experience, $50/hr, Remote, College Student
Remote Moderator, $40/hr, Weekend, No Degree, Part-Time
Live Chat Support, Remote, $42/hr, Night Shift, College Student
Phone Job, $50/hr, Remote, No Degree, Part-Time, Weekend
Data Entry, $45/hr, Remote, Evening, No Experience Required
Virtual Assistant, No Experience, $42/hr, Remote, Part-Time
Remote Customer Support, $50/hr, Night Shift, No Degree
Remote Data Entry, $40/hr, College Student Friendly, Part-Time
Live Chat Support, $42/hr, Weekend, Remote, No Degree
Virtual Assistant, Remote, $45/hr, Evening, No Experience
Remote Phone Job, $50/hr, College Student, Night Shift
Remote Moderator, $42/hr, Weekend, No Experience Required
Data Entry, No Degree, $45/hr, Part-Time, Remote Job
Customer Support, $50/hr, Remote, Evening/Night Job, No Degree
Virtual Assistant, $42/hr, Remote, Weekend, No Degree
Remote Live Chat, $45/hr, College Student, No Experience
Remote Data Entry, $40/hr, Part-Time, No Degree Required
Phone Support, $50/hr, Weekend, Remote, No Experience
Virtual Assistant, $42/hr, Evening, Remote, No Degree
Remote Customer Support, $45/hr, No Experience, Part-Time
Data Entry, $50/hr, Night Job, No Degree, Remote
Remote Moderator, $40/hr, College Student Friendly, Part-Time
Virtual Assistant, Remote, $42/hr, Weekend, No Experience
Remote Phone Job, $45/hr, Part-Time, No Degree Required
Customer Support, $50/hr, Night Job, Remote, No Experience
Data Entry, Remote, $42/hr, Evening Job, No Degree
Live Chat Support, $45/hr, Weekend, Remote, College Student
Virtual Assistant, Remote, $50/hr, Part-Time, Night Shift
Data Entry, $40/hr, No Experience, Remote, Weekend Job
Remote Phone Job, $45/hr, No Degree, College Student Friendly
Customer Support, $42/hr, Remote, Evening, No Experience
Virtual Assistant, $50/hr, Weekend, No Degree, Remote
Remote Data Entry, $40/hr, Part-Time, College Student Job
Phone Support, Remote, $42/hr, Evening/Night Shift
Virtual Assistant, No Degree, $45/hr, Remote, Part-Time
Live Chat Support, $50/hr, Remote, No Experience Required
Remote Moderator, $42/hr, College Student, Weekend Job
Data Entry, $45/hr, Remote, Night Job, No Degree
Virtual Assistant, $50/hr, Remote, Part-Time, Evening Job
Remote Customer Support, $42/hr, Weekend, No Experience
Phone Job, $45/hr, Remote, Night Shift, No Degree
Remote Live Chat, $50/hr, College Student, No Experience
Data Entry, $40/hr, Part-Time, Remote, Weekend Job
Virtual Assistant, $42/hr, Remote, No Experience, Evening
Remote Phone Support, $45/hr, Night Job, College Student
Remote Moderator, $50/hr, No Degree, Weekend, Part-Time
Virtual Assistant, $40/hr, Remote, Night Shift, No Experience
Customer Support, $42/hr, Remote, Part-Time, No Degree
Remote Data Entry, $45/hr, Weekend Job, College Student
Phone Support, Remote, $50/hr, No Experience, Night Shift
Virtual Assistant, $42/hr, Evening, Remote, College Student
Requirements
- Registered Nurse with a graduate degree from an accredited school of nursing and at least four years of nursing experience, including two years in utilization review/case management or comparable patient payment processing experience.
- Current registration with the State Board of Nursing Examiners or a temporary permit to practice nursing in the assigned state.
- Demonstrated knowledge of revenue cycle and denial management functions.
- Knowledge of healthcare including government payers, federal and state regulations, healthcare financing, and managed care.
- Experience in case management and utilization management.
- Outpatient CDI experience preferred.
- Knowledge of insurance and governmental programs, regulations, and billing processes is required.
- Working knowledge of medical terminology and medical record coding experience is highly desirable.
- Customer service background is required.
- Working knowledge of Electronic Health Records (EHR) is preferred.
- Ability to interact effectively with multidisciplinary teams, including physicians and other clinical professionals.
Nice-to-haves
- Bachelor's Degree preferred.
- Experience in writing appeals and familiarity with third-party billing requirements and regulations.
Benefits
- Competitive hourly pay range of $35.6322 - $53.4483
- Opportunities for professional development and continued education programs.
