Revenue Integrity Nurse Auditor

Duties:

The Revenue Integrity Nurse Auditor will be responsible for performing pre-billing and post-billing audits as assigned to ensure charge and claim accuracy and compliance. RI Nurse Auditor is responsible for reviewing and appealing potentially denied charge line level services performed at St. Joseph's/Candler and its affiliates where applicable.. This position is the Revenue Integrity point of contact for Pharmacy and Pharmacy Financial Management applications through the Trisus software system, working through monthly reconciliation reports, software updates, and regular meetings with Pharmacy. Acts as Pharmacy liaison between Revenue Integrity, Pharmacy, and the Trisus software product. The RI Nurse Auditor serves as a clinical expert within the Revenue Integrity department and for the Revenue Cycle team/leaders. The RI Nurse Auditor remains up to date with the various Centers of Medicare and Medicaid (CMS) and commercial/managed care insurance companies claim filing regulations, payer changes, regulatory updates; and monitors payer websites, newsletters, etc identifying and communicating changes relevant to SJ/C clinical and revenue cycle teams.

Requirements:

Registered Nurse License with State of Practice - Required

Medical Coding Certifications such as COC, CPC, CCDS-O or Certified Revenue Cycle Specialist (CRCS) or Certified Revenue Cycle Representative (CRCR) or similar certification – Required or obtain one within one year from date of hire