Revenue Integrity RN

BHS; United States; Remote; USD 75,000 - 95,000; Full time

Job summary

Baptist Health is seeking a Revenue Integrity RN to join our team in a remote capacity, with residency required in KY or IN. The role focuses on payor compliance reviews to determine medical necessity and support accurate billing.

You will obtain prior authorizations, review denials, and respond with efforts to recover revenue while meeting payor timelines. Clinical expertise and collaboration with Revenue Integrity staff are essential.

Qualifications

• Valid Kentucky licensure as a registered nurse.
• Bachelor’s degree in a related field and two years healthcare experience OR three years healthcare experience.
• Knowledge of medical terminology; payor reimbursement guidelines; denial appeal and underpayment resolution processes; and audit response timelines.
• Case Management and/or Inpatient nursing experience preferred.

Responsibilities

• Perform payor compliance review on accounts to determine medical necessity.
• Obtain predeterminations / prior authorizations when required by payor.
• Review medical necessity denials from commercial and governmental payors.
• Respond to denials or pre-denial audits with best efforts to recover revenue and prevent loss.
• Serve as clinical resource for Revenue Integrity staff.

Skills

Medical terminology

Payor guidelines

Denials handling

Audit timelines

Case management

Education

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.