Remote Revenue Integrity RN – Payor & Denials Expert

BHS; New York (NY); Remote; USD 90,000 - 110,000; Full time

Job summary

Baptist Health is seeking a Revenue Integrity RN for a remote role requiring residency in Kentucky or Indiana. The position concentrates on payor compliance reviews, predeterminations, and serving as a clinical resource for Revenue Integrity staff.

The incumbent reviews medical necessity denials, supports appeals and underpayments, and ensures timely filing and revenue recovery in alignment with payor and government timelines.

Qualifications

• Valid Kentucky licensure as a registered nurse.
• Minimum three years healthcare experience or a bachelor’s degree in a related field and two years healthcare experience.
• Knowledge of medical terminology; payor reimbursement guidelines; payor denial appeal / underpayment resolution processes; and managed care contracts.
• Government audits experience preferred.

Responsibilities

• Reviews payor compliance to determine medical necessity before and after services.
• Obtains predeterminations / prior authorizations when required.
• Reviews denials and pre-denial audits from payors and responds to recover revenue or prevent loss.
• Serves as clinical resource for Revenue Integrity staff.

Skills

Healthcare experience

Medical terminology

Payor guidelines knowledge

Denials/appeals

Education

Registered Nurse license (RN)

Bachelor's degree in a related field

Job description

Baptist Health is seeking a Revenue Integrity RN for a remote role requiring residency in Kentucky or Indiana. The position concentrates on payor compliance reviews, predeterminations, and serving as a clinical resource for Revenue Integrity staff.

The incumbent reviews medical necessity denials, supports appeals and underpayments, and ensures timely filing and revenue recovery in alignment with payor and government timelines.