Revenue Integrity Nurse Auditor

Company: Trinity Health
Location: Columbus
Posted on: February 16, 2020

Job Description:

Why Mount Carmel?With fivehospitals, over60 free-standing outpatient clinics, acollege of nursing, aMedicare Advantage plan, and extensive outreach and community wellness programs,Mount Carmel Health System serves more than a million patients in central Ohio each year, and we've been a pillar of this community for more than 130 years. As a proud member ofTrinity Health, one of the nation's largest Catholic healthcare delivery systems, our network of caring spans 22 states, 94 hospitals, and 133,000 colleagues nationwide.We know that exceptional patient care starts with taking care of our colleagues, so we invest in great people and all that we ask in return is that you come to work ready to make a difference and do the right thing.What we offer:

• Competitive compensation and benefits packages including medical, dental, and vision coverage
• Retirement savings account with employer match starting on day one
• Generous paid time off programs
• Employee recognition incentive program
• Tuition/professional development reimbursement
• Relocation assistance (geographic restrictions apply)
• Discounted tuition and enrollment opportunities at the Mount Carmel College of NursingWhy Columbus?The nation's 14th largest city, Columbus, Ohio is one of the fastest growing major metropolitan areas in the Midwest ranked #1 for population growth, #1 for job growth, #1 for wage growth, and #1 real estate market. And with a vibrant blend of professional sports, world-class attractions, creative cuisines, and a flourishing music and arts scene, you'll never be found wanting for entertainment and experiences to call your own in Columbus. Learn more atwww.experiencecolumbus.com!About the job:The Revenue Integrity Nurse Auditor is 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 RegionWhat you'll do:
  • 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 manne
  • 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.
  • Coordinates concurrent and retrospective audits of patient medical records and itemized bills, as requested by patient, third party payer, or external auditors
  • Collaborates with Revenue Integrity team on opportunities to improve and implement front-end process to support denial prevention;
  • Supports the development of effective internal controls that promote adherence to applicable local, state, federal laws, and program requirements of accreditation agencies and health plans.What we're looking for:
    • 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. 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 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.ApplyJob Number: 00190811Location: Columbus, OHOrganization Name: Mount Carmel Health SystemFacility: MCHS - Corporate Services CenterEmployment Type: Full timeHours: 40

Keywords: Trinity Health, Columbus , Revenue Integrity Nurse Auditor, Accounting, Auditing , Columbus, Ohio