Revenue Integrity RN

BHS; New York (NY); À distance; USD 90 000 - 110 000; Plein temps

Résumé du poste

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.

Responsabilités

• 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.

Connaissances

Healthcare experience

Medical terminology

Payor guidelines knowledge

Denials/appeals

Formation

Registered Nurse license (RN)

Bachelor's degree in a related field

Description du poste

SummaryJob 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.