Remote Revenue Integrity RN: Payer Compliance & Denials

BHS Baptist Healthcare System; Kentucky; Hybrid; USD 75,000 - 105,000; Full time

Job summary

Baptist Health is seeking a Revenue Integrity RN for a remote role requiring residency in Kentucky or Indiana. The RN will review payor compliance, authorize necessary pre-billing steps, and address denials to protect revenue while ensuring regulatory timelines.

The role supports the Revenue Integrity team as a clinical resource. Ideal candidates hold an RN license in KY or IN with several years of healthcare experience and knowledge of payor guidelines.

Qualifications

• Valid Kentucky license as an RN or an equivalent license in Indiana.
• Minimum three years healthcare experience or a related bachelor’s degree with two years healthcare experience.
• Knowledge of medical terminology, payor guidelines, and denial/underpayment processes.
• Familiarity with government audits and managed care contracts; case management experience preferred.

Responsibilities

• Perform payor compliance reviews to determine medical necessity for services and billing.
• Obtain predeterminations and prior authorizations when required by payors.
• Review denials from commercial and government payors and respond with corrective actions.
• Adhere to payor timelines and clinical guidelines while recovering revenue.
• Serve as a clinical resource for Revenue Integrity staff.

Skills

Healthcare experience

Payor reimbursement knowledge

Medical terminology

Audit response planning

Education

RN license in KY or IN

Job description

Baptist Health is seeking a Revenue Integrity RN for a remote role requiring residency in Kentucky or Indiana. The RN will review payor compliance, authorize necessary pre-billing steps, and address denials to protect revenue while ensuring regulatory timelines.

The role supports the Revenue Integrity team as a clinical resource. Ideal candidates hold an RN license in KY or IN with several years of healthcare experience and knowledge of payor guidelines.