Revenue Integrity Nurse Auditor PRN
Assist in resolving billing edits that are holding patient claims from billing, by reviewing medical records and other applicable documentation. Maintain the integrity of facility STAR Charge Description Master (CDM), HSM and all Revenue Integrity Processes. Maintain the integrity of all Ancillary Department systems related to billing and revenue. Research and handles all processes regarding the charge master not limited to adding new charges, modifying and inactivating charges from the CDM. Ensuring all applicable coding and billing guidelines are met. Position will work with Ancillary Department staff to research alternative processes regards to charge related improvements and billing compliance issues. Position will coordinate all retrospective, concurrent, patient complaint and external billing audits. Provide monthly audit results. Develop and coordinate educational in-services to the Business Office staff and Ancillary staff related to charging and billing issues. Review denial trends for documentation or charging issue opportunities. Review high charge stays/procedures for charging accuracy. Ensures Issues logs, Unbilled reports are addressed properly and timely. Stay abreast of governmental and non governmental payors to ensure facility charging meet compliance and clinical documentation processes in place will support charges. Perform various QA reviews to ensure timely and appropriate charging, documentation to support charging, appropriate coding at charge level and all UB04 fields. The Revenue Integrity Nurse Auditor position interprets policies and procedures, recommends changes as appropriate, and provides revelant feedback to the Business Office, Admissions, and Facility leadership, etc.
MINIMUM KNOWLEDGE, SKILLS AND ABILITIES REQUIRED:
Minimum of 10 years direct related work experience may substitute degree requirement.
EDUCATION & TRAINING:
Registered Nurse Degree, a plus
- Excellent communication skills both verbal and written.
- Good interpersonal skills.
- Able to establish good customer relationships with trust and respect.
- Computer skills - navigation and edit resolution through various Web based systems. Ability to use email, Excel, Word.
EQUAL OPPORTUNITY EMPLOYER MINORITIES / WOMEN / VETERANS / DISABLED