Nurse Auditor, Revenue Integrity

This is a fully remote position, open to applicants in Michigan.

📋 Description

• Oversee revenue integrity and charge-related denials in collaboration with the Patient Business Service center.

• Ensure that clinical documentation is both compliant and thorough.

• Support the handling of denials and associated audits.

• Discover opportunities to enhance revenue optimization.

• Conduct detailed and regular chart assessments.

• Educate clinical colleagues on relevant topics.

• Monitor identified trends effectively.

• Utilize clinical knowledge and established procedures to swiftly address charge-related trends.

• Deliver necessary training to responsible parties.

• Carry out retrospective charge reviews and provide assistance with third-party charge audits.

• Monitor Revenue Integrity-related audits and recognize trends.

• Work together with Revenue Integrity, PBS, and department colleagues to educate and report to key stakeholders.

• Act as a resource contact, supplying clinical information to colleagues and payers.

• Collaborate with the Revenue Integrity team to enhance and establish front-end denial-prevention strategies.

• May require travel between regional locations.

⛳️ Requirements

• High school diploma or GED is required.

• Completion of an accredited program relevant to the license is necessary.

• Must possess a license in the applicable state(s) of engagement.

• A valid driver’s license is required if specified by the assignment.

• A minimum of four (4) years of nursing experience is necessary.

• Proven knowledge of revenue cycle and denial management operations.

• Experience in case management and utilization management is essential.

• A customer service background is required.

• Registered Nurse designation is preferred.

• A Bachelor’s degree is preferred.

• Preferred: at least two (2) years of experience in charge audit, managed care, or similar patient payment processing.

• Strongly preferred: AAPC, AHIMA, CHRI certification/membership.

• Outpatient CDI experience is preferred.

• Working knowledge of Electronic Health Records (EHR) is preferred.

• Ability to adhere to relevant laws, regulations, policies, procedures, and guidelines.

• Proficient in using computers and other technologies.

• Capable of lifting up to 30 pounds unassisted when required.

• Ability to travel between locations within the region as needed.

🏝️ Benefits

• Remote work position available.

• Equal Opportunity Employer.