Nurse Auditor, Revenue Integrity - (Remote)

About the Role

The Nursing Support (NS) colleague (uncertified, certified, unlicensed, or licensed) provides safe, quality health care services and/or assistance to patients under the supervision and direction of a registered nurse or other designated health care professional in accordance with level of experience, education, policies, and procedures.

Responsibilities

• Performs clinical care activities (direct or indirect) for patients within the “scope of practice” laws and training received.
• Cares for patients safely by assisting in clinical care services or engaging in administrative activities (e.g., maintaining records or supplies) that enhance or improve coordination, preparation, and flow of the care experience.
• Knows, understands, and incorporates basic or essential area of practice (document, coordinate, communicate) and training standards.
• Uses clear, effective, respectful language and communication methods/means.
• Performs work in a safe, engaging, and supportive manner; influences the responsible use of resources; accountable for continuous self-development and supporting the growth of others.
• Maintains a working knowledge of applicable federal, state, and local laws/regulations, Trinity Health Integrity & Compliance Program & Code of Conduct, as well as other policies, procedures, and guidelines.
• For NS IV – licensed role:
  • Provides nursing interventions or clinical knowledge application in decision-making.
  • Participates in the planning, implementation, and/or evaluation of and solutions for care.
  • Performs delegated focused/holistic care autonomously according to care plan.
  • May administer medication and carry out therapeutic treatment within scope of license (state and Trinity Health policy).
  • Performs direct and essential care or supportive activities as part of an interdisciplinary team with a deeper understanding, including theoretical knowledge.
  • Demonstrates independence to perform activities with general oversight, improving outcomes safely through personal contributions, teamwork, and initiatives.
  • Advocates for patients and informs/counsels patients and families about illness and care details.
  • May serve as a knowledge resource, role model, and mentor or lead/coordinate/supervise direct and essential care activities of unlicensed/licensed/certified healthcare professionals within licensed scope of practice.
• For NS IV Addendum role:
  • Coordinates revenue integrity/charge-related denials with Patient Business Service (PBS) center.
  • Ensures compliant and complete clinical documentation, assists with denials and related audits, and identifies opportunities for revenue optimization.
  • Performs thorough and routine chart reviews, provides education to clinical colleagues, and tracks identified trends.
  • Leverages clinical knowledge and standard procedures to ensure timely attention to charge-related trends and provides necessary education.
  • Responsible for retrospective charge reviews and assistance with third-party charge audits.
  • Ensures tracking of all Revenue Integrity-related audits, identifying trends, and collaborating with other Revenue Integrity, PBS, and/or departmental colleagues on education and reporting.
  • Serves as a resource contact, providing clinical information as requested by intra- and inter-departmental colleagues and payers.
  • Collaborates with the Revenue Integrity team on opportunities to improve and implement front-end processes to support denial prevention.
  • May require traveling between locations within the region.

Requirements

• High school diploma or GED.
• Completion of an accredited program associated with license.
• License in the applicable state(s) of engagement.
• Valid driver’s license where required by assignment.

Additional Qualifications (Preferred)

• Registered Nurse.
• For NS IV Addendum role:
  • Four (4) or more years of nursing experience.
  • Demonstrated knowledge of revenue cycle and denial management functions.
  • Knowledge of and experience in case management and utilization management.
  • Customer service background.
  • Bachelor’s degree.
  • Two (2) or more years of charge audit, managed care, or comparable patient payment processing experience.
  • AAPC, AHIMA, CHRI certification/membership.
  • Outpatient CDI experience.
  • Working knowledge of Electronic Health Records (EHR).

Physical & Mental Requirements

• Exposure to conditions which may be unpleasant to sight, touch, sound, and/or smell.
• Occasional exposure to fumes, odors, dusts, mists, gases, biohazards/hazards (mechanical, electrical, burns, chemicals, radiation, sharp objects, etc.).
• Occasional exposure to noise, infectious waste, diseases, and conditions.
• Occasional exposure to interruptions, shifting priorities, and stressful situations.
• Frequent ability to follow tasks through to completion, understand and relate to complex ideas/concepts, remember multiple tasks and regimens over long periods, and work on concurrent tasks/projects.
• Frequent ability to read small print, hear sounds and voice/speech patterns, give/receive instructions and other verbal communications (in-person and/or over the phone/computer/device/equipment assigned) with some background noise.
• Frequent ability to perform manual dexterity activities and/or grasping/handling.
• Continuous ability to climb, kneel, crouch, and/or operate foot controls.
• Occasional use of a computer/other technology.
• Frequent ability to sit with the ability to vary/adjust physical position or activity.
• Frequent ability to maintain a safe working environment and use available personal protective equipment (PPE).
• Continuous ability to comply with Trinity Health’s Code of Conduct, policies, procedures, and guidelines.
• Occasional ability to provide assistance in the event of an emergency.
• For Direct Healthcare Services:
  • Perform activities that require standing/walking with the ability to vary/adjust physical position or activity.
  • Occasional lifting of a maximum of 30 pounds unassisted.
  • Occasional use of upper and lower extremities, engage in bending/stooping/reaching and pushing/pulling.
  • Occasional work indoors (subject to travel requirements) under temperature-controlled and well-lit conditions.
  • Continuous encounter of worksites (e.g., patient homes) or travel to worksites that may have variable internal and external environmental conditions.
  • Occasional performance of work that involves physical efforts (e.g., transporting, moving, positioning, and/or ambulating patients).
• For Indirect Healthcare/Support Services:
  • Perform activities that require standing/walking with the ability to vary/adjust physical position or activity.
  • Occasional lifting of a maximum of 30 pounds unassisted.
  • Occasional experience of long periods of walking/standing/stooping/bending/pulling and/or pushing.
  • Occasional encounter of a clinical/patient-facing/hands-on interactive work environment.
  • Occasional work indoors (subject to travel requirements) under temperature-controlled and well-lit conditions.
  • Continuous work outdoors with variable external environmental conditions.

Pay

Pay Range: $32.5171 - $48.7757 per hour.