Clinical Nurse Auditor – Rev Cycle
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Job Description
Clinical Nurse Auditor handling clinical reviews and collaborating on authorization issues for healthcare services. Assisting in quality improvement and patient care processes within the revenue cycle.
Responsibilities:
- 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.
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