Revenue Integrity Nurse Auditor - RN
Location: Hyde Park, IL
Hours : Monday - Friday
The Finance Revenue Cycle Department is currently seeking an RN Nurse Auditor.
RN Clinical Nurse Auditor – Job Summary
In this role, the Internal Nurse Auditor reviews patient charge statements and identifies services performed but not properly captured on the patient's bill as well as defends properly documented and delivered services which are being challenged by their party payors or their agents. Contacts departments and outside parties to gather documentation related to patient charges and services.
RN Clinical Nurse Auditor – Essential Job Functions
- Reviews patient charge statements and identifies services performed but not properly captured on the patient's bill as well as defends properly documented and delivered services which are being challenged by their party payors or their agents.
- Performs data analysis and verifies information to ensure records are accurate, and provides reports on findings to management.
- Provides recommendations for correcting unsatisfactory conditions, improving procedures, and reducing costs.
- Utilizes computer systems to evaluate data, and substantiates the validity of reported information.
- Researches and clarifies issues related to patient charge statement and contacts departments/third party payors to resolve issues. .
- Assists management in establishing and implementing policies and procedures for internal controls to ensure compliance with regulations.
- Performs other duties and projects as assigned.
- Able to review patient charge statements and identify services performed but not properly captured on the patient's bill; as well as defend properly documented and delivered services which are being challenged by third party payers or their agents.
- Contact departments and outside parties to gather documentation related to patient charges and services.
- Complete clinical documentation reviews to justify medical necessity, and writing medical necessity appeals.
- Contacting insurance payers as needed to resolve/clarify denial issues related to level of care and reason for payment denials.
- Must have the clinical background needed to make a quick decision after reviewing admission / discharge record and the ability to translate this decision into action based upon timely filing deadlines established by various insurance payers.
- Utilize current coding and reference tools to evaluate the appropriateness of documented CPT/HCPCS codes.
- Able to utilize basic Microsoft Office applications, and other electronic applications related to job performance.
- Other duties may include but are not limited to: verifying insurance eligibility, obtaining pre-authorizations for specific services, and communicating effectively with all departmental stake holders.
RN Nurse Auditor - Qualifications
- 1-2 years of auditing medical records/medical claims experience.
- Excellent communication and writing skills, ability to work effectively on multiple projects simultaneously, problem solving ability, and team player.
- Excellent mathematical skills, proficient in Microsoft Office applications, and applicable computer systems. Ability to serve as a resource for staff and/or temporary workers in the department.
RN Nurse Auditor - Required Education & Licenses/Certifications
- RN license State of Illinois
- B.S.N. degree
Why Join Us?
We've been at the forefront of medicine since 1899. We provide superior healthcare with compassion, always mindful that each patient is a person, an individual. To accomplish this, we need employees with passion, talent and commitment… with patients and with each other. We're in this together: working to advance medical innovation, serve the health needs of the community, and move our collective knowledge forward. If you'd like to add enriching human life to your profile, The University of Chicago Medicine is for you. Here at the forefront, we're doing work that really matters. Join us. Bring your passion.
Bring your career to the next level at a hospital that is thriving; from patient satisfaction to employee engagement, we are at the Forefront of Medicine. Take advantage of all we have to offer and #BringYourPassiontotheForefront
University of Chicago Medicine is growing; discover how you can be a part of this pursuit of excellence at: www.uchospitals.edu/jobs
The University of Chicago Medical Center is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, ethnicity, ancestry, sex, sexual orientation, gender identity, marital status, civil union status, parental status, religion, national origin, age, disability, veteran status and other legally protected characteristics.
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