Revenue Integrity Charge Auditor

Fully Remote

Lake Park Building

Full time

R188249

Job Description:

The Revenue Integrity RN Charge/Coding Auditor is responsible for consulting on clinical charge Audits for Intermountain Health. The RN Charge Auditor will execute clinical charge audits of medical records on behalf of Intermountain hospitals and clinics for denials review, defense audits, disallowed charges, and retrospective reviews, and will serve as clinical resource for all Intermountain Health Revenue Cycle departments. Incumbent ensures a high level of knowledge of laws, rules, regulations, hospital charging and coding, clinical quality and clinical policy guidelines necessary to guarantee compliance and protection of information.

This role will actively manage, maintain, and communicate all levels of denial activity to stakeholders throughout the denial process up to and including medical review boards and in the court of law.

We are committed to offering flexible work options where approved and stated in the job posting. However, we are currently not considering candidates who reside or plan to reside in the following states:
California, Connecticut, Hawaii, Illinois, Massachusetts, Maine, Minnesota, New York, Pennsylvania, Rhode Island, Virginia Vermont, Washington. Please note that a video interview through Microsoft Teams will be required as well as potential onsite interviews and meetings. ”Video phone screens and interview(s) through Microsoft Teams will be required as well for fully remote position.

Essential Functions

• Use nationally recognized evidence-based utilization review criteria (such as Milliman Care Guidelines (MCG) or Inter Qual) to determine viability for commercial and governmental insurance audits using supporting documentation.
• 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. Provide guidance with policy and procedure development, training and support, and applicable clinical education focused to reduce clinical denials.
• Develop and maintain a thorough understanding of projects and assigned functions, including utilization of technology, products, organizational activities and systems.
• Complete ongoing education and CEU requirements to maintain licensure and certifications.

Skills

• Collaboration
• Problem solving
• Critical thinking
• Detail-oriented
• Sound clinical judgement
• Effective communication (both written and oral)
• Patient/hospital advocacy
• Computer literacy
• Efficiency oriented
• Results Focused

Minimum Qualifications

• Graduate of an accredited school of nursing. Bachelor of Science in Nursing (BSN) from an accredited institution. Education is verified.
• 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.
• Demonstrates clear understanding of the healthcare revenue cycle.

Preferred Qualifications

• Master of Science in Nursing (MSN) from an accredited institution. Education is verified.
• 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 /…