Revenue Integrity Nurse Spec
Department : PFS Revenue Cycle Initiatives
Status : Full Time w/Benefits
Shift: Days
The Revenue Integrity Nurse Specialist will be the liaison between the Revenue Integrity Team and the Clinical Department Managers and designated Charge Champions to assist with ongoing maintenance of the CDM, chart-to-bill audits and charge capture processes utilizing the revenue cycle tools available. A schedule of ongoing internal audits for review and monitoring of high volume, high cost, and/or problem prone areas will be maintained by the Revenue Integrity Nurse Specialist for each designated service line. The revenue cycle audits are conducted to ensure that the clinical documentation contained within the patient chart supports the charges that appear on the patient�s bill, and to ensure the accuracy and completeness of charge capture. Where clinical documentation does not support charges appearing on the bill, the Revenue Integrity Nurse Specialist will prepare a report of exceptions and offer solutions to the applicable department. The Revenue Integrity Nurse Specialist will ensure complete and timely responses communicating the results of each audit to the Revenue Integrity Team and will work directly with the Department Managers and Charge Champions to seek resolution and compliance. Responses to audits will come in the form of both verbal conferences and a written of findings.
Bachelor of Science in Nursing preferred. Prior nursing (hospital experience) and auditing experience, 5+ years preferred. Certificates, Licenses and Registrations required: Registered Nurse (RN); Coding Certification preferred; Certified in CDM Master�, CCA�, and Crosswalk� required. Strong customer service and analytical skills required. Understanding of coding, insurance and billing requirements. Strong working knowledge of medical terminology, patient care services, and medical record chart documentation including inpatient and outpatient. Working knowledge of chart/bill audits and ability to abstract medical information. Strong PC skills, specifically proficient with Microsoft Office Suite. Ability to work independently. Ability to complete tasks accurately and on time and to manage deadlines. Strong analytical, verbal and written communication skills in the English language. Must be reliable and dependable with consistent work attendance. Must work well with other employees. Must be able to perform critical work under deadlines. Must be willing to work overtime if requested by management.