RN Utilization & Revenue Integrity Specialist

Beth Israel Lahey Health; Burlington (VT); On-site; USD 80,000 - 107,000; Full time

Job summary

Beth Israel Lahey Health is seeking a Utilization Analyst to validate medical necessity of hospital care by coordinating with physicians, payers and inpatient case management. You will review documentation, educate providers on proper coding and utilization, and collaborate with multiple teams to drive reimbursement accuracy.

Requirements include RN licensure with 5 years inpatient UR/CM experience; a Bachelor's degree is desirable, with CDIP/CCM/ACM certifications highly desirable.

Qualifications

• Must have at least 5 years inpatient UR/CM experience.
• RN licensure required; CDIP/CCM/ACM desirable.
• Knowledge of payment methodologies, federal and state regulations, organization and communication skills required.

Responsibilities

• Completes initial reviews of patient records within 24-48 hours of admission and evaluates medical necessity.
• Conducts follow-up reviews of patients daily per payer requirements.
• Communicates with Attending physicians regarding status determinations and documentation.
• Educates physicians and providers on documentation needs and appropriate level of care.
• Collaborates with case managers, nursing, coding, physicians and finance on relevant issues.
• Analyzes data and trends to identify opportunities for improvement.
• Prepares utilization review monitoring/trending reports for physician and leadership review.

Skills

UR/CM experience

Inpatient experience

Education

RN

Bachelor's degree desirable

CDIP certification

CCM certification

ACM certification

Job description

Beth Israel Lahey Health is seeking a Utilization Analyst to validate medical necessity of hospital care by coordinating with physicians, payers and inpatient case management. You will review documentation, educate providers on proper coding and utilization, and collaborate with multiple teams to drive reimbursement accuracy.

Requirements include RN licensure with 5 years inpatient UR/CM experience; a Bachelor's degree is desirable, with CDIP/CCM/ACM certifications highly desirable.