Trinity Health
Join to apply for the
Revenue Integrity - Nurse Auditor
role at
Trinity Health Description: Responsible for coordinating denials with Patient Business Service (PBS) 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. May require travelling between locations within the region. Employment Type: Full time Licensure/Certification: MINIMUM QUALIFICATIONS Registered Nurse or Licensed Vocational Nurse/ Licensed Practical Nurse and graduate of an accredited school of nursing, plus at least four (4) years of nursing experience and two (2) years of charge audit, managed care or comparable patient payment processing experience preferred. 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. AAPC, AHIMA, CHRI certification/membership strongly preferred. Requirements: 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. Our Commitment: Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are 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, veteran status, or any other status protected by federal, state, or local law.
#J-18808-Ljbffr
Revenue Integrity - Nurse Auditor
role at
Trinity Health Description: Responsible for coordinating denials with Patient Business Service (PBS) 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. May require travelling between locations within the region. Employment Type: Full time Licensure/Certification: MINIMUM QUALIFICATIONS Registered Nurse or Licensed Vocational Nurse/ Licensed Practical Nurse and graduate of an accredited school of nursing, plus at least four (4) years of nursing experience and two (2) years of charge audit, managed care or comparable patient payment processing experience preferred. 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. AAPC, AHIMA, CHRI certification/membership strongly preferred. Requirements: 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. Our Commitment: Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are 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, veteran status, or any other status protected by federal, state, or local law.
#J-18808-Ljbffr