Clinical Nurse Auditor – Rev Cycle
Job Description: • Working with pre-certification / authorization / denials teams to assist in obtaining up front authorization for services rendered. • Assisting with denial management and resolution. • Collaborating with HIM, PFS, Case Management and multiple clinical departments to resolve account problems related to authorization of services and account resolution. • Reviewing protocols to assist in ensuring services being billed as standard of care are evidenced based and meeting industry guidelines. • Evaluating and resolving issues related to the revenue cycle including medical documentation, utilization review and medical necessity. • Providing training to improve revenue cycle processes. • Recommending policies and procedures improvements to increase efficiencies • Supporting process improvement activities to assure medical record compliance Requirements: • Bachelor Degree in Nursing • 2 or more years experience in utilization review, clinical review, or authorizations • Licensed Registered Nurse (LRN) - Multi-State - State Board of Nursing • Current State RN license • EPIC experience Benefits: • The health system is an equal employment opportunity employer. • Provides reasonable accommodations to qualified individuals with disabilities. Apply To this Job