Revenue Integrity Charge Auditor

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

📋 Description

• Provide consultation on clinical charge audits for Intermountain Health.

• Conduct clinical charge audits of medical records for denial reviews, defense audits, disallowed charges, and retrospective assessments.

• Act as a clinical resource for Revenue Cycle departments within Intermountain Health.

• Stay informed about laws, regulations, hospital charging and coding, clinical quality, and policy guidelines.

• Ensure compliance and safeguard information.

• Oversee, manage, and communicate denial activities to stakeholders throughout the denial process, including medical review boards and legal proceedings.

• Utilize evidence-based criteria for utilization reviews to assess eligibility for commercial and governmental insurance audits.

• Evaluate clinical appeal requests by reviewing payer policies and Federal/State regulations.

• Collaborate with multidisciplinary stakeholders during audits.

• Identify and communicate the root causes of denials to healthcare team members.

• Serve as a subject matter expert in hospital charging, documentation requirements, clinical disease processes and treatments, and medical necessity determinations.

• Assist clinical departments with audit research and regulatory analysis.

• Provide guidance on policy and procedure development, training, and clinical education to mitigate clinical denials.

• Maintain awareness of assigned projects, technologies, products, organizational activities, and systems.

• Fulfill ongoing education and CEU requirements to uphold licensure and certifications.

⛳️ Requirements

• Graduate of an accredited nursing school.

• Bachelor of Science in Nursing (BSN) from an accredited institution; education will be verified.

• Current licensure as a registered nurse is mandatory.

• Active coding certification from AAPC or AHIMA required.

• Proficient in Microsoft Office, electronic medical record systems, and electronic databases.

• Extensive knowledge of the healthcare claim denial process.

• Strong understanding of the healthcare revenue cycle.

• Ability to apply nationally recognized evidence-based utilization review criteria such as Milliman Care Guidelines (MCG) or InterQual.

• Capability to evaluate clinical appeal requests using payer policies and Federal/State regulations.

• Video phone screens and interviews via Microsoft Teams are required.

• Potential for onsite interviews and meetings.

• Candidates must not reside or intend to reside in California, Connecticut, Hawaii, Illinois, Massachusetts, Maine, Minnesota, New York, Pennsylvania, Rhode Island, Virginia, Vermont, or Washington.

• Preferred qualifications: Master of Science in Nursing (MSN), experience with EPIC, clinical experience in hospital care settings or auditing, utilization review and/or case management experience, hospital insurance billing, third-party claim/charging audits, or healthcare auditing experience.

• Skills in collaboration, problem-solving, critical thinking, attention to detail, clinical judgment, written and verbal communication, patient/hospital advocacy, computer proficiency, efficiency, and results orientation.

🏝️ Benefits

• Comprehensive benefits package that supports wellness, health, security, connection, and engagement.

• Flexible work options where approved and specified.

• Remote work opportunity available.

• Company-provided equipment in accordance with remote work expectations.

• Support for ongoing education and CEU requirements to maintain licensure and certifications.