DRG Nurse Auditor

6 days ago

Richmond, United States UHS Full time
Responsibilities

One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500 corporation, annual revenues were $14.3 billion in 2023. During the year, UHS was again recognized as one of the World's Most Admired Companies by Fortune; and listed in Forbes ranking of America's Largest Public Companies.

Headquartered in King of Prussia, PA, UHS has approximately 96,700 employees and continues to grow through its subsidiaries. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom.

Atlantic Region CBO (uhs.com)

The Atlantic Region CBO is seeking a dynamic and talented DRG Nurse Auditor with clinical case management experience to be responsible for analyzing clinical claim denials, drafting detailed appeal letters, evaluating clinical level of care, and the review of denial trends.

Key Responsibilities include:
  • Perform DRG (Diagnosis Related Group) validation reviews in response to audits from third party payers.
  • Review audit findings letters from third party payers to obtain a clear understanding of audited diagnosis codes and underlying payer clinical/coding rationale.
  • Analyze medical records to obtain supporting clinical documentation for billed diagnosis codes.
  • Communicate findings to third party payers in detailed appeal letters to prevent downgrade payment recoveries.
  • Make decisions to update DRGs or remove or add to billed diagnose codes based on clinical reviews.
  • Call third party payers and physician offices as needed to obtain additional clinical details.
  • Identify audit trends and provide feedback to management and to UHS acute care facilities.
  • Adherence to all applicable laws, regulations and guidelines.
  • Other duties as assigned.
Benefit Highlights
  • Challenging and rewarding work environment
  • Competitive Compensation & Generous Paid Time Off
  • Excellent Medical, Dental, Vision and Prescription Drug Plans
  • 401(K) with company match and discounted stock plan
  • SoFi Student Loan Refinancing Program
  • Career development opportunities within UHS and its 300+ Subsidiaries
  • More information is available on our Benefits Guest Website: benefits.uhsguest.com
Contact Information:
  • Nicole Baez
  • HR Coordinator/Recruiter
  • Nicole.baezRojas@uhsinc.com

Qualifications

Position Requirements:
  • RN or LPN licensure in good standing is required. BSN degree preferred
  • Three to five years of experience is preferred
  • Working knowledge of coding regulations including ICD-10, DRGs, and HCPCs.
  • CPC, CCS or other coding credentials preferred, but not required
  • CDI Experience is preferred.
  • CCDS certification is preferred.
  • Experience working in Patient Financial Services and an understanding of the Revenue Cycle from beginning to end is preferred.
  • Experience working in case management or audit with technical denials is preferred.
  • Strong Microsoft Office skills (Excel, Word, Outlook)
  • Customer focused both internally and externally, strong attention to detail, the ability to multi-task.
  • Excellent written and oral communication skills are required.
EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.

Avoid and Report Recruitment Scams

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.

If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.

  • Nurse Auditor

    4 weeks ago

    Richmond, Virginia, United States Universal Health Services Full time

    Job Title: Nurse AuditorWe are seeking a skilled Nurse Auditor to join our team at Universal Health Services. As a Nurse Auditor, you will be responsible for resolving billing edits, coordinating and completing billing audits, educating business office and facility staff on charging and billing issues, and reviewing denial trends and high charge stays for...

  • Nurse Auditor

    3 weeks ago

    Richmond, Virginia, United States Universal Health Services Full time

    Job SummaryWe are seeking a skilled Nurse Auditor to join our team at Universal Health Services. As a key member of our clinical case management team, you will be responsible for resolving billing edits, coordinating and completing billing audits, and educating business office and facility staff on charging and billing issues.Key ResponsibilitiesPerform...

  • RN - CDI Specialist

    3 weeks ago

    Richmond, Virginia, United States Reid Hospital & Health Care Services Full time

    Overview of the RoleThe RN - CDI Specialist position at Reid Health is a critical role that requires a skilled and detail-oriented individual to ensure accurate and complete clinical documentation. As a Second Level Reviewer, you will be responsible for reviewing medical records to verify that all conditions are accurately reported.Key...

  • Clinical Case Manager

    2 weeks ago

    Richmond, California, United States Universal Health Services Full time

    Job SummaryWe are seeking a skilled Nurse Auditor to join our team at Universal Health Services. As a key member of our Patient Financial Services department, you will be responsible for resolving billing edits, coordinating and completing billing audits, and educating business office and facility staff on charging and billing issues. Your expertise will...

  • RN-Case Manager

    3 weeks ago

    Richmond, United States Reid Hospital & Health Care Services Full time

    Find your WHY at Reid Health The Case Manager is accountable for the organization, sequence of services, and resources that are medically necessary and appropriate for the achievement of patient care outcomes within effective time frames. The Case Manager coordinates with the interdisciplinary team to expedite medically appropriate, cost-effective patient...

  • Health Assistant

    3 weeks ago

    Richmond, Texas, United States Health & Human Services Comm Full time

    Job Title: Health AssistantJob Summary:The Health Assistant will work within the Behavioral Health Department performing routine duties that support the learning of practical, functional, and meaningful skills, while decreasing challenging behavior.Key Responsibilities:Assist behavioral health specialists and behavior analysts in the development of Skills...

  • Maintenance Supervisor I

    3 weeks ago

    Richmond, Texas, United States Health & Human Services Comm Full time

    Job Summary:This is a challenging and rewarding role that requires a high level of expertise in maintenance and construction supervision. The successful candidate will be responsible for planning, assigning, and scheduling staff for the installation, care, and repair of state facilities and equipment. They will also oversee the work of others, ensuring that...

  • Administrative Assistant

    3 weeks ago

    Richmond, Texas, United States Health & Human Services Comm Full time

    Job Summary:The Unit Clerk is responsible for performing a variety of administrative tasks to support the daily operations of the unit. This includes filing and maintaining client records, computing ICF/MR staffing ratios, and maintaining assigned unit's virtual client folders. The Unit Clerk will also provide typing and receptionist duties as needed. Key...

  • Rehabilitation Therapy Technician

    3 weeks ago

    Richmond, Texas, United States Health & Human Services Comm Full time

    Job Summary:The Rehabilitation Therapy Technician (RTT) performs moderately complex habilitative and rehabilitative therapy work. Provides assistance to therapists for an assigned therapeutic specialty, (e.g., music therapy, therapeutic recreation, dance/movement therapy, occupational therapy, physical therapy, psychology, or vocational/day...