Remote Revenue Integrity RN (KY/IN)

BHS; United States; Remote; USD 75,000 - 95,000; Full time

Job summary

Baptist Health is seeking a Revenue Integrity RN to join our team in a remote capacity, with residency required in KY or IN. The role focuses on payor compliance reviews to determine medical necessity and support accurate billing.

You will obtain prior authorizations, review denials, and respond with efforts to recover revenue while meeting payor timelines. Clinical expertise and collaboration with Revenue Integrity staff are essential.

Qualifications

• Valid Kentucky licensure as a registered nurse.
• Bachelor’s degree in a related field and two years healthcare experience OR three years healthcare experience.
• Knowledge of medical terminology; payor reimbursement guidelines; denial appeal and underpayment resolution processes; and audit response timelines.
• Case Management and/or Inpatient nursing experience preferred.

Responsibilities

• Perform payor compliance review on accounts to determine medical necessity.
• Obtain predeterminations / prior authorizations when required by payor.
• Review medical necessity denials from commercial and governmental payors.
• Respond to denials or pre-denial audits with best efforts to recover revenue and prevent loss.
• Serve as clinical resource for Revenue Integrity staff.

Skills

Medical terminology

Payor guidelines

Denials handling

Audit timelines

Case management

Education

Bachelor's degree in related field

Job description

Baptist Health is seeking a Revenue Integrity RN to join our team in a remote capacity, with residency required in KY or IN. The role focuses on payor compliance reviews to determine medical necessity and support accurate billing.

You will obtain prior authorizations, review denials, and respond with efforts to recover revenue while meeting payor timelines. Clinical expertise and collaboration with Revenue Integrity staff are essential.