Revenue Integrity Charge Auditor RN

Intermountain Healthcare Inc.; Topeka (KS); Remote; USD 57,000 - 86,000; Full time

Job summary

Intermountain Health in Utah is seeking a Revenue Integrity RN Charge/Coding Auditor for a fully remote, full-time role. You will conduct clinical charge audits of medical records to support denials review, defense audits, and retrospective reviews, acting as a clinical resource across hospital revenue cycle departments.

You will apply knowledge of charging, coding, and regulatory guidelines to ensure compliance and protect information.

Qualifications

• Current RN licensure required.
• Active coding certification through AAPC or AHIMA.
• Experience with Microsoft Office, EMR systems and electronic databases.
• In-depth knowledge of the healthcare claim denial process.
• Clear understanding of the healthcare revenue cycle.

Responsibilities

• Use evidence-based criteria to determine viability for audits.
• Assess the appropriateness of clinical appeal requests per policies and regulations.
• Collaborate with multidisciplinary stakeholders during the audit process.
• Identify and communicate root causes for denials with the healthcare team.
• Serve as a subject matter expert for hospital charging, documentation, and medical necessity decisions.
• Support clinical departments with policy development, training and education.
• Develop and maintain understanding of projects and systems.
• Complete ongoing education and CEU requirements to maintain licensure.

Skills

Collaboration

Problem solving

Critical thinking

Detail-oriented

Clinical judgement

Effective communication

Patient advocacy

Computer literacy

Efficiency oriented

Results oriented

Education

RN licensure

Coding certification (AAPC/AHIMA)

Tools

EPIC

EMR systems

Microsoft Office

Job description

Fully Remote

Lake Park Building

Full time

R188249

Job Description:

The Revenue Integrity RN Charge/Coding Auditor is responsible for consulting on clinical charge Audits for Intermountain Health. The RN Charge Auditor will execute clinical charge audits of medical records on behalf of Intermountain hospitals and clinics for denials review, defense audits, disallowed charges, and retrospective reviews, and will serve as clinical resource for all Intermountain Health Revenue Cycle departments. Incumbent ensures a high level of knowledge of laws, rules, regulations, hospital charging and coding, clinical quality and clinical policy guidelines necessary to guarantee compliance and protection of information. This role will actively manage, maintain, and communicate all levels of denial activity to stakeholders throughout the denial process up to and including medical review boards and in the court of law.

We are committed to offering flexible work options where approved and stated in the job posting. However, we are currently not considering candidates who reside or plan to reside in the following states: California, Connecticut, Hawaii, Illinois, Massachusetts, Maine, Minnesota, New York, Pennsylvania, Rhode Island, Virginia Vermont, Washington. Please note that a video interview through Microsoft Teams will be required as well as potential onsite interviews and meetings.

Video phone screens and interview(s) through Microsoft Teams will be required as well for fully remote position.

Essential Functions

• Use nationally recognized evidence-based utilization review criteria (such as Milliman Care Guidelines (MCG) or InterQual) to determine viability for commercial and governmental insurance audits using supporting documentation.
• Assess the appropriateness of clinical appeal requests by identifying and analyzing payer policies and Federal/State regulations.
• Collaborate with multidisciplinary stakeholders during the audit process.
• Identify and communicate root causes for denials with members of the healthcare team.
• Serve as a subject matter expert for hospital charging, documentation requirements, clinical disease processes and treatment, and medical necessity decisions.
• Support ancillary clinical-based departments as it relates to audits by research and analysis of regulatory information. Provide guidance with policy and procedure development, training and support, and applicable clinical education focused to reduce clinical denials.
• Develop and maintain a thorough understanding of projects and assigned functions, including utilization of technology, products, organizational activities and systems.
• Complete ongoing education and CEU requirements to maintain licensure and certifications.

Skills

• Collaboration
• Problem solving
• Critical thinking
• Detail-oriented
• Sound clinical judgement
• Effective communication (both written and oral)
• Patient/hospital advocacy
• Computer literacy
• Efficiency oriented
• Results Focused

Minimum Qualifications

• 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.

Preferred Qualifications

• Master of Science in Nursing (MSN) from an accredited institution. Education is verified.
• Graduate of an accredited school of nursing. Bachelor of Science in Nursing (BSN) from an accredited institution. Education is verified.
• EPIC experience
• Demonstrated Clinical experience in hospital care settings or previous auditing experience.
• Demonstrated experience in utilization review and/or case management, hospital insurance billing, third party claim / charging audits or auditing in healthcare setting.

Physical Requirements

• Ongoing need for employee to see and read information, labels, monitors, identify equipment and supplies, and be able to assess customer needs.
• Frequent interactions with customers require employees to communicate as well as understand spoken information, alarms, needs, and issues quickly and accurately.
• Manual dexterity of hands and fingers to manipulate complex and delicate equipment with precision and accuracy. This includes frequent computer, phone, and cable set-up and use.
• For roles requiring driving: Expected to drive a vehicle which requires sitting, seeing and reading signs, traffic signals, and other vehicles.

Location:

Lake Park Building

Work City:

West Valley City

Work State:

Utah

Scheduled Weekly Hours:

40

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.

$41.20 - $62.17

We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Learn more about our comprehensive benefits package here (https://intermountainhealthcare.org/careers/benefits) .

By applying for a position with Intermountain, I acknowledge that I will comply with all applicable Intermountain policies and expectations. If applying for a remote or hybrid role, this includes remote work expectations related to confidentiality, information security, work schedules, conflicts of interest, and use of company equipment. I further acknowledge that outside employment or activities may not interfere with job responsibilities or create a conflict of interest with Intermountain. Actual or reasonably perceived conflicts may be grounds for disqualification from consideration or, if hired, corrective action up to and including termination of employment.

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

At Intermountain Health, we use the artificial intelligence ("AI") platform, HiredScore to improve your job application experience. HiredScore helps match your skills and experiences to the best jobs for you. While HiredScore assists in reviewing applications, all final decisions are made by Intermountain personnel to ensure fairness. We protect your privacy and follow strict data protection rules. Your information is safe and used only for recruitment. Thank you for considering a career with us and experiencing our AI-enhanced recruitment process.

All positions subject to close without notice.

Headquartered in Utah with locations in six primary states and additional operations across the western U.S., Intermountain Health is a nonprofit system of 34 hospitals, 400+ clinics, a medical group of more than 4,800 employed physicians and advanced care providers, a health plan division called Select Health with more than one million members, and other health services. Helping people live the healthiest lives possible, Intermountain is widely recognized as a leader in clinical quality improvement and efficient healthcare delivery.

Join our world-class team and embark on a career filled with opportunities, strength, innovation, and fulfillment.

Intermountain Health strives to make the application process accessible to all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact 1-800-843-7820 or email [e-mail] . This contact information is for accommodation requests only and cannot be used to inquire about the status of applications.

Intermountain Health’s PEAK program supports caregivers in the pursuit of their education goals and career aspirations by providing up-front tuition coverage paid directly to the academic institution. The program offers 100+ learning options to choose from, including undergraduate studies, high school diplomas, and professional skills and certificates. Caregivers are eligible to participate in PEAK on day 1 of employment. Learn more. (https://intermountainhealthcare.org/careers/working-for-intermountain/employee-benefits/peak-program/)

The primary intent of this job description is to set a fair and equitable rate of pay for this classification. Only those key duties necessary for proper job evaluation and/or labor market analysis have been included. Other duties may be assigned by the supervisor.

All positions subject to close without notice.

Thanks for your interest in continuing your career with our team!