Providence St. Joseph Health is calling a Revenue Integrity Nurse Auditor to work remotely within our footprint states: AK, CA, MT, OR, TX and/or WA.
The Nurse Auditor is responsible for providing patient focused, standardized, compliant revenue cycle support that will assist Providence St Joseph Health to in meeting financial objectives.
Conduct audits (individual chart/bill audits, focus audits, compliance audits, payer defense audits and patient requests for audit).
Review and assess the accuracy of charges and CPT/HCPCS coding, the documentation of orders and clinical documentation to support charges, and the processes used by the ancillary departments for insuring charge capture and appropriate documentation.
Analyze audit results and report findings to promote and improve compliant processes.
Assist in the research and coordination of compliance related information for the compliance program.
Provide recommendations to align with best practices.
Appeal and manage the lack of payment (denials) from insurance plans (Payors).
Work collaboratively with the Payors, RCS, Case Management, Admitting and Medical Records to resolve existing denials and maximize processes to reduce future denials for accurate and timely reimbursement.
Educate ministries on regulatory procedures to maintain compliance and integrity of the revenue cycle and charge capture.
Serve as Subject Matter Expert on multiple processes and procedures to assist management with projects relating to the Compliance program.
• Independently conduct revenue audits including bill audits, focus audits, compliance audits, government audits and patient requests. Gather and review all necessary clinical documentation and compare to the final edited bill. Use clinical expertise and knowledge of Medicare or payer billing requirements, to evaluate the accuracy of billed charges and hospital’s compliance with Medicare and other billing rules.
• Develop, monitor, and report key measurements, trends and audit results to RI-CDM management.
• Collaborate with facilities to identify minimum specifications and/or processes each need in place to support compliant and accurate clinical documentation that supports medical necessity and other regulatory requirements.
• Collaborate with facilities to identify and develop needed resources to provide education and evaluation of clinical documentation.
• Interpret and communicate regulatory standards and their implications to clinicians and key internal constituents.
• Document and communicate recurring problems, including business impact and possible resolutions.
• Take initiative in investigating and resolving claim and charging issues.
• Independently address patient, department and administrative requests for a variety of issues related to revenue and charge integrity.
• Reduce reporting variations by working with business office departments to identify issues impeding accurate, timely and relevant reporting.
• Manage payer denials after the Hospital PFS or Case Manager identifies the denial by gathering/reviewing all necessary clinical and non-clinical documentation.
• Review recommendations as subject matter expert to ensure recommendations are sustainable.
• Work with RI-CDM Department and Internal Audit, providing audit related assistance as needed.
• Investigate medical record and charge entry discrepancies, analyze information, and make recommendations for corrections or process improvements.
• Serve as a primary revenue integrity resource and liaison for charge producing departments, RBO, HIM-Coding, Case Management and Admitting.
Associate's Degree or Bachelor's Degree in Nursing.
5 years Clinical experience in an acute care setting.
Experience working with revenue cycle team members to accomplish specific objectives.
Experience in a high production, deadline-oriented professional work environment requiring multi-tasking, flexibility, and self-directed work.
Proven track record in identifying and resolving inefficiencies in charge capture and revenue cycle processes.
A track record in organizing and planning with demonstrated ability to effectively manage time and achieve results in a fast paced environment.
3 years working in case management or similar function in an acute care setting
3 years of experience actively utilizing EPIC and the reporting functions.
1 year experience in a multi-hospital and/or integrated healthcare system.
1 year familiarity with Revenue Cycle processes.
Case Management Healthcare Professional.
Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.
About the department you will serve.
One Revenue Cycle (ORC) is the name adopted to reflect the Providence employees who work throughout Providence Health & Services (PH&S) in revenue cycle systems and structures in support of our ministries and operations in all regions from Alaska to California. ORC’s objective is to ensure our core strategy, One Ministry Committed to Excellence, is delivered along with the enhanced overall patient care experience (know me, care for me, ease my way) by providing a robust foundation of services, operational and technical support, and the sharing of comprehensive, relevant, and highly specialized revenue cycle expertise.
We offer a full comprehensive range of benefits — see our website for details — http://www.providenceiscalling.jobs/rewards-benefits
At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.
Requsition ID: 139334
Company: Providence Jobs
Job Category: Revenue Cycle Operations
Job Function: Revenue Cycle
Job Schedule: Full time
Job Shift: Day
Career Track: Nursing
Department: 4001 SS RC CHARGE DECR MSTR
Address: OR Portland 4400 NE Halsey St
Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.