Set your sights on a role making a real difference in the healthcare system. We’re looking for a self-motivated Revenue Integrity Nurse Auditor to join our team. We have a relentless focus on driving results for our customers and enabling them to invest more into patient care; in turn, this allows us to continue to grow our company and your career.
- When identifying any data defects, escalates to manager or team lead as necessary
- Responds to ad-hoc requests and develops potential solutions to present to manager or team lead in a timely manner
- Performs quality control audits by verifying the accuracy of entered data to ensure the integrity, completeness and proper usage of systems and data
- Perform daily maintenance of billing work queues, ensuring accuracy and compliance with Medicare and other federal agency regulations
- Managing time effectively, performing tasks accurately and meeting set timelines
- Identify root cause issues and escalate to Revenue Integrity Analyst or Manager, as appropriate
- Attend client held meetings supporting revenue cycle processes as they pertain to your role
- Prioritizes own work based on hospital needs and CMS requirements
- Most work will be assigned by Team Lead
- Discusses next steps with Team Lead when previous task has been completed
- Focus should be consistently working existing work queues
- May take on additional responsibility from team lead or leaders
- There are 2 levels within the Auditor Job Description (Professional I and II)
- Higher level auditors complete more detailed account review, have more experience, or have higher credentials
- Department Requests
- Billing Work Queues (R1 ePARS or other):
- Customer Complaints
- Revenue Integrity work
- RCS Account Review
- Observation Hours Calculation and Carve-Out Review
- Compliance Audits
- Hospital Leadership Audit Requests
- External Audits (Managed Care, Defense, RAC)
- Defends or supports charges disputed by third party payer audits
- Split Billing (Cosmetic, Organ Donors, Self-Audits) Charge Review
- Keeps updated on various billing rules to ensure charges that are identified in audits are split and rebilled properly
- Coordinates and facilitates clinical functions required for the patient accounting functions
- Assists coders with clinical documentation issues and works as a liaison for charging and billing staff
- Identifies and prepares charges to be corrected on accounts
- Works fluidly with Patient Financial Services and other system departments to communicate audit results
- Provides summary reports and analysis to hospital staff and management as required
- Team Standardization & Process Improvements
- Recommends solutions to improve charge capture accuracy
- Provides educate and training to staff and physicians on identified revenue cycle compliance issues in order to prevent future issues
- Develops yearly audit plans according to set audit findings with Team Lead/Manager
- CDM and/or Revenue Integrity Subject Matter Knowledge
- Attend meetings/educational sessions to maintain knowledge base; maintaining credentials as applicable
- Specialized review of accounts for billing work queues
- Comprehensive knowledge of Revenue Cycle, hospital coding, and client software (e.g. Invision, EPIC, etc.)
- Act as subject matter expert for responsible areas, communicating knowledge to clients and internal staff
- Registered nurse with current license (RN) in your state
- Knowledge of clinical documentation processes and procedures
- Knowledge of medical terminology
R1 is changing healthcare by infusing operational discipline and proprietary technology in hospital financial processes. We are an industry leader; we are the only independent organization with a comprehensive service and technology offering for hospital revenue cycle management, and we have achieved leading outcomes for our customers.
- A strong financial performing, growing organization that will keep you on your toes with new ideas, changes and opportunities to learn and grow in abundance.
- A culture of excellence, driving customer success so they can focus on improving patient care and on giving back to the community.
- A Total Rewards package which may include such things as: competitive compensation package, the ability to choose from a comprehensive benefit program mostly funded by R1 that includes medical, dental, vision, flexible spending accounts, commuter benefits, life and disability insurance, along with work life balance programs including paid time off for personal time, illness and volunteering, and we offer a retirement savings plan and continuing training and development and so much more!
Sound like you? Let’s talk!
R1 is a leading provider of revenue cycle management services and Physician Advisory Services to healthcare providers. We are the largest independent end-to-end revenue cycle provider and have the longest operating history in the revenue cycle industry. R1’s objective is to be the one trusted partner to manage revenue so providers and patients can focus on what matters most. Our distinctive operating model and values includes people, processes, and sophisticated integrated technology/analytics that help customers realize sustainable improvements in their operating margins and improve the satisfaction of their patients, physicians, and staff. We are dedicated to transforming the commercial infrastructure and patient experience in healthcare.