Revenue Integrity RN

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

Summary Job Description: Baptist Health is looking for a Revenue Integrity RN to join our team! This is a remote work position that requires residency in KY or IN Performs payor compliance review on accounts to determine medical necessity of services, pre and post service as well as pre and post billing. Obtains predeterminations / prior authorizations when required by payor. Reviews medical necessity denials from commercial and governmental payors, including pre-denial audits performed by RACs or similar Medicare and Medicaid programs. Responds to all denials or pre-denial audits with best possible efforts to recover outstanding revenue or prevent future revenue loss, meeting all appropriate payor or government timelines. Serves as clinical resource for other Revenue Integrity staff.

Qualifications: Valid Kentucky licensure as a registered nurse. Minimum three years healthcare experience (nursing, registration, patient accounting, financial services, managed care or a related field) or a bachelor’s degree in a related field and two years healthcare experience. Requires knowledge of medical terminology; payor reimbursement guidelines (authorization / notification, medical necessity, and timely filing guidelines); payor denial appeal / underpayment resolution processes; and managed care contracts. Individuals working with government audits must have a keen understanding of all audit response requirements and timelines. Case Management and/or Inpatient nursing experience strongly preferred.

Baptist Health is an Equal Employment Opportunity employer.

Founded in 1924 in Louisville, Kentucky, Baptist Health is a full-spectrum health system dedicated to improving the health of the communities it serves.

The Baptist Health family consists of 10 hospitals, employed and independent physicians, and more than 470 points of care, including outpatient facilities, physician practices and services, urgent care clinics, outpatient diagnostic and surgery centers, home care, fitness centers, and occupational medicine and physical therapy clinics.

Baptist Health’s eight owned hospitals include more than 2,300 licensed beds in Corbin, Elizabethtown, La Grange, Lexington, Louisville, Paducah, Richmond and New Albany, Indiana.

Baptist Health also operates two joint venture hospitals: the 410-bed Baptist Health Deaconess Madisonville in Madisonville, Kentucky with Deaconess Health System based in Evansville, Indiana, and the Baptist Health Rehabilitation Hospital, a 40-bed inpatient rehabilitation facility with Encompass Health, based in Birmingham, Alabama.

Baptist Health employs more than 24,000 people in Kentucky and surrounding states.

Baptist Health is the first health system in the U.S. to have all of its hospitals recognized by the American Nursing Credentialing Center with either a Magnet® or Pathway to Excellence® designation for nursing excellence.

Baptist Health’s employed provider network, Baptist Health Medical Group, has more than 1,820 employed providers offering care in 78 specialties, including approximately 862 physicians and 958 advanced practice clinicians.

Baptist Health’s physician network also includes more than 2,000 independent physicians.

EEO Statement: Baptist Health is an Equal Employment Opportunity employer, and seeks to employ individuals without regard to race, color, national origin, gender, sexual orientation, gender identity, age, disability, marital status, citizenship status, military status, religious or political beliefs, protected veteran status, employment status or any other protected class identified in any federal, state, or local law.

Baptist Health specifically encourages minority, female, disabled, veteran and other candidates from diverse backgrounds to apply and strengthen our team.

Please note that Baptist Health is a drug-free workplace and employment with Baptist Health is subject to post offer, pre-employment drug testing.

NOTICE OF NONDISCRMISSION AND ACCESSIBILITY TO SERVICES Persons with hearing and speech impairments can contact Baptist Health facilities by using the Kentucky Relay Service, a toll-free telecommunication device for the deaf (TDD). For voice to TDD, call 800.648.6057. For TDD to voice, call 800.648.6056. Job Applicant Privacy Policy Statement - Job Applicant Privacy Policy