Location: Albany,NY, USA
Employment Type:
Full time
Shift:
Day Shift
Description:
Revenue Integrity Nurse Auditor - Remote - St. Peter's Hospital - FT Days
If you are looking for a full time position, this could be your opportunity. Here at St. Peter's Health Partners, we care for more people in more places.
What you will do:
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.
Responsibilities:
* Conducts monthly internal charge audits (compares medical record to charges) to ensure charging integrity.
* 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.
* Coordinates denial management processes (i.e., clinical and administrative/technical accounts) for Revenue Integrity department, focusing upon retrospective follow-up, which may include assisting in appeal processing with the objective of appropriately maximizing reimbursement based upon services delivered and ensuring claims are paid/settled in the most timely manner.
* Coordinates concurrent and retrospective audits of patient medical records and itemized bills as needed.
* Provides detailed understanding or aptitude for resolving denials based on patient status, length of stay, level of care, missing pre-certification, or other clinical reasons and constructing warranted appeals for defined populations.
What you will need:
* Registered Nurse and graduate of an accredited school of nursing plus at least 4 years of nursing experience, including 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.
* Bachelor's Degree preferred.
* Must possess a demonstrated knowledge of revenue cycle and denial management functions
* Knowledge 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.
* 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.
* Customer service background is required. Working knowledge of Electronic Health Records (EHR) is preferred.
* Ability to interact effectively with multidisciplinary teams, including physicians and other clinical professionals internally and externally.
* Possesses detailed understanding or aptitude to learn and understand denials resolution based on patient status, length of stay, level of care, missing pre-certification, or other clinical reasons.
* Must possess in-depth familiarity with third party billing requirements and regulations, and writing appeals.
Pay Range: $34.05-50.00hr
Pay is based on experience, skills, and education. Exempt positions under the Fair Labor Standards Act (FLSA) will be paid within the base salary equivalent of the stated hourly rates. The pay range may also vary within the stated range based on location.
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.