Revenue Integrity Nurse Auditor

JOB SUMMARY:

The primary responsibility of this position is to provide clinical expertise in the Revenue Cycle. This position must be able to read and understand documentation in the patient’s medical record. This position will be expected to understand billing and compliance regulations and will expand that knowledge through continuing education. This position is an important part of providing excellent and expert customer services for Livingston HealthCare’s patients, patient families, and coworkers.

This position will assist with authorization of services, and appealing denials which need clinical expertise. This will include reviewing the medical record and responding in a timely manner to the billers, customer service representatives, reimbursement specialists and patients. This position will work with departments to minimize lost charges, reduce denials, post assigned specialty charges, and help implement processes to reach these goals.

This position must be able to communicate complex concepts in terms that the listener can understand. This position is responsible for accurately answering questions, providing feedback to the inquirer, noting the hospital revenue cycle system, and reconciliation of the accounts. This position will assist with coding/billing/compliance audits as needed. This position coordinates response and all correspondence relating to No Surprises Act disputes.

This position must be self-motivated and detail oriented. Analytical skills, working knowledge of the various systems and departmental processes are essential.

This position is an Onsite position, and will not be a Telecommuting position.

Schedule:

• 1.0FTE (40 hours)
• Monday- Friday
• 8 Hour Days
• No Weekend or Holiday Requirements

Compensation:

• $35.82/hr DOE
• Robust Benefits Package

ESSENTIAL FUNCTIONS, DUTIES AND RESPONSIBILITIES:

1. Provides clinical expertise to Revenue Cycle. This includes reviewing medical record and responds to billers, customer service, and others as needed to educate, investigate, and resolve issues.
2. Works with Preauthorization staff to obtain prior authorizations for services.
3. Coordinates response and correspondence to the No Surprise Act Independent Dispute Process.

4. Coordinates all elements related to the payor audits and disputes, patient requested audits, and charge capture auditing

5. Works in a timely manner for all tasks and communications.

6. Demonstrates and builds a knowledge of billing, coding, and compliance guidelines and conventions

7. Audits and posts specialty charge reconciliation as assigned

8. Attends Case Management Meetings

9. Excellent communication skills.

10. Prepares pricing estimate for expected services based on approved LHC methods.

11. Communicates with patient via established methods the expectations of LHC business services.

12. Interprets and explains expected charges, services, and hospital policy regarding payment of bills to patients and their families.

13. Ability to instruct and educate.

14. Communicate and interface with hospital personnel, medical staff, patients, and family members to ensure high-quality patient care and excellence in customer service.

15. Perform related duties as assigned.

16. Excellent research abilities

17. Patient and customer focuse

QUALIFICATIONS (Required):

1. Associates or Bachelor of Science in Nursing perferred.
2. 3 years’ experience in hospital, clinic, payor organization setting preferred.
3. Auditing experience preferred.
4. Working knowledge of hospital charging, billing, system interfaces, contract adjustments preferred
5. Knowledge of CPT/HCPCS procedural coding and Charge Description Masters strongly preferred.
6. Experience with PCs, word processing, spreadsheet, graphics, and database software applications is desired.
7. Ability to work independently, efficiently and accurately prioritizing varying workloads required. Strong quantitative, analytical, and organization skills required.
8. Excellent communication skills to deal effectively with the public, department staff, hospital staff, and medical staff required.
9. Positive attitude to work effectively with department staff required.

ADDITIONAL DESIRABLE QUALIFICATIONS:

1. Mature personality, sense of responsibility, and integrity.
2. Excellent organizational skills and time management skills.
3. Analytical and decision making skills.
4. Ability to multi task and maintain a flexible daily work schedule.
5. Seek opportunities to provide quality customer service.