Revenue Integrity RN

Baptist Health; Louisville (KY); Remote; USD 65,000 - 90,000; Full time

Job summary

Baptist Health is seeking a Revenue Integrity RN to join our team in a remote role requiring residency in KY or IN. You will review payor medical necessity for services, obtain predeterminations and respond to denials or audits to recover revenue and minimize losses.

The ideal candidate has KY RN licensure, 3+ years in healthcare, and knowledge of payor guidelines and audit processes. Case management or inpatient nursing experience is preferred.

Qualifications

• Valid Kentucky licensure as a registered nurse.
• 3+ years healthcare experience or a Bachelor's in related field with 2 years healthcare experience.
• Knowledge of medical terminology; payor guidelines; audit response timelines.
• Case management and/or inpatient nursing experience preferred.

Responsibilities

• Perform payor compliance reviews to determine medical necessity.
• Obtain predeterminations or prior authorizations as required.
• Review denials from governmental and commercial payors and respond to audits to recover revenue.
• Serve as a clinical resource for Revenue Integrity staff.

Skills

Medical terminology

Payor guidelines

Denial appeals

Underpayment resolution

Managed care contracts

Case management

Education

Kentucky RN license

Bachelor's degree in related field

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.