Remote RN Revenue Integrity Auditor — Charge/Coding

Intermountain Healthcare Inc.; Carson City (NV); Remote; USD 57,000 - 86,000; Full time

Job summary

Intermountain Health is seeking a Revenue Integrity RN Charge/Coding Auditor to conduct clinical charge audits and support denial management across Intermountain hospitals and clinics. You will utilize nationally recognized criteria to assess medical records for denials, retrospective reviews, and disallowed charges, driving compliance and safeguarding information.

The ideal candidate holds a BSN, current RN licensure, and a coding certification (AAPC or AHIMA).

Qualifications

• Graduate of an accredited school of nursing. BSN from an accredited institution. Education is verified.
• Current licensure as a registered nurse required.
• Current coding certification through AAPC or AHIMA.
• Experience in Microsoft Office, electronic medical record systems and electronic databases
• Demonstrates in depth knowledge of the healthcare claim denial process.
• Demonstrates clear understanding of the healthcare revenue cycle.

Responsibilities

• Use evidence-based utilization review criteria (MCG or InterQual) to determine viability for audits using supporting documentation.
• Assess the appropriateness of clinical appeal requests by identifying payer policies and Federal/State regulations.
• Collaborate with multidisciplinary stakeholders during the audit process.
• Identify and communicate root causes for denials with healthcare team members.
• Serve as a subject matter expert for hospital charging, documentation requirements, and medical necessity decisions.
• Support ancillary clinical-based departments as it relates to audits by researching and analyzing regulatory information; provide policy and procedure guidance, training, and education.
• Develop and maintain understanding of projects and assigned functions, including utilization of technology and systems.
• Complete ongoing education and CEU requirements to maintain licensure and certifications.

Skills

Collaboration

Problem solving

Critical thinking

Detail-oriented

Clinical judgement

Communication

Patient advocacy

Computer literacy

Efficiency oriented

Results Focused

Education

Bachelor of Science in Nursing (BSN)

RN licensure

Coding certification (AAPC/AHIMA)

Tools

EPIC experience

Microsoft Office

Job description

Intermountain Health is seeking a Revenue Integrity RN Charge/Coding Auditor to conduct clinical charge audits and support denial management across Intermountain hospitals and clinics. You will utilize nationally recognized criteria to assess medical records for denials, retrospective reviews, and disallowed charges, driving compliance and safeguarding information.

The ideal candidate holds a BSN, current RN licensure, and a coding certification (AAPC or AHIMA).