Nurse Auditor, Revenue Integrity
Position Purpose:
Responsible for coordinating denials with Patient Business Service (PBS) center and ensures compliant and complete clinical documentation, assists with denials and related appeals, and identifies opportunities for revenue optimization. Investigates denials and root causes, which includes performing thorough chart reviews, providing education to clinical colleagues and tracking of identified trends. Leverages clinical knowledge and standard procedures to ensure timely attention to denials as requested by PBS and applicable appeal data gathering. Responsible for third party charge audits and trauma reviews. May be require to travel between locations within the Region.
Minimum Requirements:
Registered Nurse and graduate of an accredited school of nursing plus at least four (4) years of nursing experience, including two (2) years of utilization review/case management, managed care or comparable patient payment processing experience. Must have current registration with the State Board of Nursing Examiners or have a temporary permit to practice nursing in the assigned state (Ohio). Bachelor's Degree preferred. Must possess a demonstrated knowledge of revenue cycle and denial management functionsKnowledge of and experience in health care including government payers, applicable federal and state regulations, healthcare financing and managed care.Knowledge of and experience in case management and utilization management.Knowledge of insurance and governmental programs, regulations and billing processes (e.g., Medicare, Medicaid, Social Security Disability, Champus, Supplemental Security Income Disability, etc.), managed care contracts and coordination of benefits is required. Working knowledge of medical terminology, and medical record coding experience (ICD-9, CPT, HCPCS) are highly desirable.This is a remote opportunity for someone with an Ohio RN license. They will work Monday - Friday day shift.
Position Highlights and Benefits:
Competitive compensation and benefits packages including medical, dental, and vision with coverage starting on day one.Retirement savings account with employer match starting on day one. Generous paid time off programs.Employee recognition programs.Tuition/professional development reimbursement.Relocation assistance (geographic and position restrictions apply). Discounted tuition and enrollment opportunities at the Mount Carmel College of Nursing.Employee Referral Rewards program.Mount Carmel offers DailyPay - if you’re hired as an eligible colleague, you’ll be able to see how much you’ve made every day and transfer your money any time before payday. You deserve to get paid every day!Opportunity to join Diversity, Equity, and Inclusion Colleague Resource Groups.Ministry/Facility Information:
Mount Carmel, a member of Trinity Health, has been a transforming healing presence in Central Ohio for over 135 years. Mount Carmel serves over 1.3 million patients each year at our four hospitals, free-standing emergency centers, outpatient facilities, surgery centers, urgent care centers, primary care and specialty care physician offices, community outreach sites and homes across the region. Mount Carmel College of Nursing offers one of Ohio's largest undergraduate, graduate, and doctor of nursing programs. If you’re seeking a rewarding career where your purpose, passion, and desire to make a difference come alive, we invite you to consider joining our team. Here, care is provided by all of us For All of You!
Our Commitment to Diversity and Inclusion
Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.