Description
The Revenue Integrity RN Charge/Coding Auditor is responsible for consulting on clinical charge audits for Intermountain Health. This role executes clinical charge audits of medical records on behalf of Intermountain hospitals and clinics for denials review, defense audits, disallowed charges, and retrospective reviews. The incumbent serves as a clinical resource for all Intermountain Health Revenue Cycle departments. They ensure a high level of knowledge of laws, rules, regulations, hospital charging and coding, clinical quality, and clinical policy guidelines to guarantee compliance and protection of information. This role actively manages, maintains, and communicates all levels of denial activity to stakeholders throughout the denial process, up to and including medical review boards and in the court of law.
Essential Functions:
- Use nationally recognized evidence-based utilization review criteria to determine viability for commercial and governmental insurance audits.
- Assess the appropriateness of clinical appeal requests by identifying and analyzing payer policies and Federal/State regulations.
- Collaborate with multidisciplinary stakeholders during the audit process.
- Identify and communicate root causes for denials with members of the healthcare team.
- Serve as a subject matter expert for hospital charging, documentation requirements, clinical disease processes and treatment, and medical necessity decisions.
- Support ancillary clinical-based departments as it relates to audits by research and analysis of regulatory information.
Skills:
- Collaboration
- Problem solving
- Critical thinking
- Detail-oriented
- Sound clinical judgement
- Effective communication
- Patient/hospital advocacy
- Computer literacy
- Efficiency oriented
- Results Focused
Minimum Qualifications:
- Graduate of an accredited school of nursing with a Bachelor of Science in Nursing (BSN) from an accredited institution.
- Current licensure as a registered nurse required.
- Current coding certification through AAPC or AHIMA.
- Experience in Microsoft office, electronic medical record systems, and electronic databases.
- Demonstrates in-depth knowledge of the healthcare claim denial process and the healthcare revenue cycle.
Preferred Qualifications:
- Master of Science in Nursing (MSN) from an accredited institution.
- EPIC experience.
- Demonstrated clinical experience in hospital care settings or previous auditing experience.
- Demonstrated experience in utilization review and/or case management, hospital insurance billing, third-party claim/charging audits, or auditing in a healthcare setting.
Physical Requirements:
- Ongoing need for employee to see and read information, labels, monitors, identify equipment and supplies, and be able to assess customer needs.
- Frequent interactions with customers require employees to communicate as well as understand spoken information, alarms, needs, and issues quickly and accurately.
- Manual dexterity of hands and fingers to manipulate complex and delicate equipment with precision and accuracy.
Location: Lake Park Building Scheduled Weekly Hours: 40
The hourly range for this position is $41.20 - $62.17.
We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.