**Employment Type:** Full time **Shift:** Day Shift **Description:** This position requires a nurse's license (RN/LPN/LVN) in the state of residency **Position Purpose** This Nurse Auditor responsible for coordinating denials with Patient Business Service center and ensures compliant and complete clinical documentation, assists with denials and related audits, 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 retrospective charge reviews, and Outpatient CDI reviews and assistance with third party charge audits. **What you will do** + Coordinates denial management processes + Ensures tracking of denials and all Revenue Integrity- related audits, identifying trends, and collaborating with other Revenue Integrity, PBS and/or departmental colleagues on education and reporting to key stakeholders. + Collaborates with intra-department and PBS teams on accurate documentation and reporting of key performance indicators and participates in development of action plans to ensure goals are met + Coordinates retrospective audits of patient medical records and itemized bills, as requested by patient, third party payer, or external auditors + Interprets data, draws conclusions, and reviews findings departmental teams. **Minimum Qualifications** + Registered Nurse (RN) or Licensed Vocational Nurse/ Licensed Practical Nurse (LPN) bachelor's degree preferred + Four (4) years of nursing experience and two (2) years of charge audit, managed care or comparable patient payment processing experience preferred. + Must possess a demonstrated knowledge of revenue cycle and denial management functions. AAPC, AHIMA, CHRI certification/membership strongly preferred. + Knowledge of and experience in health care including government payers, applicable federal and state regulations, healthcare financing and managed care, case and utilization management. + Outpatient CDI experience preferred. + 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. + Must possess in-depth familiarity with third party billing requirements and regulations. **Position Highlights and Benefits** + Full time 40hrs salaried M-F days + Excellent benefits starting day 1 **Ministry/Facility Information** Trinity Health Of New England is an integrated health care delivery system that is comprised of world-class providers and facilities dedicated to full spectrum preventative, acute, and post-acute care. We aim to deliver top level care to increase our community's overall health at lower costs. While we serve nearly 3 million people, we are proud to be a part of a national system that focuses on putting our patients first and having the best colleagues to do so. **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. Our Commitment to Diversity and Inclusion Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions. Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity. EOE including disability/veteran