Revenue Integrity Nurse Auditor

3 weeks ago

Chesapeake, Virginia, United States Children's Hospital Of The King's Daughters Full time

Job Summary

The Revenue Integrity Nurse Auditor is a critical role at Children's Hospital Of The King's Daughters, responsible for ensuring accurate and complete reimbursement from third-party payers. This position requires a strong clinical background, excellent analytical skills, and the ability to communicate effectively with various professionals.

Key Responsibilities

  • Ensure adherence to regulatory requirements related to billing and supporting documentation.
  • Facilitate the completion of appeals in a timely manner.
  • Prepare trend and other reports for compliance audits and charge processes.
  • Serve as a resource to hospital departments regarding compliance with billing regulations and trends in denials of services.
  • Conduct compliance, defense, LifeNet, and special focus audits, and report findings.
  • Serve as a clinical resource for coding, denial management, and customer service issues.
  • Participate as a member of the chargemaster team, providing clinical support and expertise on compliance-related charge functioning.
  • Identify and work collaboratively to correct discrepancies in patient charges.

Requirements

  • Current Virginia state license as a Registered Nurse or Registered Nurse holding a valid Compact State license.
  • Certified Professional Coder required.
  • Certified Outpatient Coder (COC; formerly CPC-H) required within 1 year of hire.
  • Graduate of a Bachelors of Science in Nursing program required.
  • Minimum of 3 years of clinical experience as a Certified Professional Coder required.
  • Three to five years of case management utilization review, or compliance-related work experience in a hospital setting preferred.
  • Pediatric experience preferred.

Working Conditions

The Revenue Integrity Nurse Auditor will work in a normal office environment with little exposure to excessive noise, dust, temperature, and the like.

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