Remote Revenue Integrity RN (KY/IN)

Baptist Health; Louisville (KY); Remote; USD 65,000 - 90,000; Full time

Job summary

Baptist Health is seeking a Revenue Integrity RN to join our team in a remote role requiring residency in KY or IN. You will review payor medical necessity for services, obtain predeterminations and respond to denials or audits to recover revenue and minimize losses.

The ideal candidate has KY RN licensure, 3+ years in healthcare, and knowledge of payor guidelines and audit processes. Case management or inpatient nursing experience is preferred.

Qualifications

• Valid Kentucky licensure as a registered nurse.
• 3+ years healthcare experience or a Bachelor's in related field with 2 years healthcare experience.
• Knowledge of medical terminology; payor guidelines; audit response timelines.
• Case management and/or inpatient nursing experience preferred.

Responsibilities

• Perform payor compliance reviews to determine medical necessity.
• Obtain predeterminations or prior authorizations as required.
• Review denials from governmental and commercial payors and respond to audits to recover revenue.
• Serve as a clinical resource for Revenue Integrity staff.

Skills

Medical terminology

Payor guidelines

Denial appeals

Underpayment resolution

Managed care contracts

Case management

Education

Kentucky RN license

Bachelor's degree in related field

Job description

Baptist Health is seeking a Revenue Integrity RN to join our team in a remote role requiring residency in KY or IN. You will review payor medical necessity for services, obtain predeterminations and respond to denials or audits to recover revenue and minimize losses.

The ideal candidate has KY RN licensure, 3+ years in healthcare, and knowledge of payor guidelines and audit processes. Case management or inpatient nursing experience is preferred.