Revenue Nurse Auditor-E - PSJH
Company: St. Joseph Health / Covenant Health
Posted on: March 28, 2020
We are looking for a Revenue Nurse Auditor-E - PSJH with Revenue
Integrity at Revenue Cycle Services LLC.Location: Orange,
California (Remote/Virtual Position)Schedule: Full time -
BiweeklyShift: 8-Hour, DaysJob Summary:The Nurse Auditor is
responsible for providing patient focused, standardized, compliant
revenue cycle support that will assist Providence St Joseph Health
to in meeting financial objectives.Conduct audits (individual
chart/bill audits, focus audits, compliance audits, payer defense
audits and patient requests for audit). Review and assess the
accuracy of charges and CPT/HCPCS coding, the documentation of
orders and clinical documentation to support charges, and the
processes used by the ancillary departments for insuring charge
capture and appropriate documentation. Analyze audit results and
report findings to promote and improve compliant processes. Assist
in the research and coordination of compliance related information
for the compliance program. Provide recommendations to align with
best practices. Appeal and manage the lack of payment (denials)
from insurance plans (Payors). Work collaboratively with the
Payors, RCS, Case Management, Admitting and Medical Records to
resolve existing denials and maximize processes to reduce future
denials for accurate and timely reimbursement. Educate ministries
on regulatory procedures to maintain compliance and integrity of
the revenue cycle and charge capture. Serve as Subject Matter
Expert on multiple processes and procedures to assist management
with projects relating to the Compliance program.The Nurse Auditor
performs all duties in a manner that promotes Providence St. Joseph
mission, values, and philosophy. In all aspects, he/she serves as a
role model for the values and mission of the organization.Essential
- Independently conduct revenue audits including bill audits,
focus audits, compliance audits, government audits and patient
requests. Gather and review all necessary clinical documentation
and compare to the final edited bill. Use clinical expertise and
knowledge of Medicare or payer billing requirements, to evaluate
the accuracy of billed charges and hospitals compliance with
Medicare and other billing rules.
- Develop, monitor, and report key measurements, trends and audit
results to RI-CDM management.
- Collaborate with facilities to identify minimum specifications
and/or processes each need in place to support compliant and
accurate clinical documentation that supports medical necessity and
other regulatory requirements.
- Collaborate with facilities to identify and develop needed
resources to provide education and evaluation of clinical
- Interpret and communicate regulatory standards and their
implications to clinicians and key internal constituents.
- Document and communicate recurring problems, including business
impact and possible resolutions.
- Take initiative in investigating and resolving claim and
- Independently address patient, department and administrative
requests for a variety of issues related to revenue and charge
- Reduce reporting variations by working with business office
departments to identify issues impeding accurate, timely and
- Manage payer denials after the Hospital PFS or Case Manager
identifies the denial by gathering/reviewing all necessary clinical
& non-clinical documentation.
- Review recommendations as subject matter expert to ensure
recommendations are sustainable.
- Work with RI-CDM Dept and Internal Audit, providing audit
related assistance as needed.
- Investigate medical record and charge entry discrepancies,
analyze information, and make recommendations for corrections or
- Serve as a primary revenue integrity resource and liaison for
charge producing departments, RBO, HIM-Coding, Case Management and
- Other duties as assigned.Minimum Position Qualifications:
- Associate's Degree or Bachelor's Degree in Nursing.
- 5 years clinical experience in an acute care setting.
- 3 years experience actively utilizing MEDITECH/EPIC and the
- Excellent organizational skills.
- Ability to work within tight timeframes and meet strict
- Certified Nurse, upon hirePreferred Position Qualifications:
- Master's Degree in Nursing, Health Care Administration, or
- 1 year experience in a multi-hospital and/or integrated
- 3 years Minimum 3 years working in case management or similar
function in an acute care setting.
- 1 year Familiarity with Revenue Cycle processes.
- Case Management Healthcare Professional, upon hireSt. Joseph
Health (SJH) is an integrated healthcare delivery system sponsored
by the St. Joseph Health Ministry and organized into three regions:
Northern California, Southern California, West Texas/Eastern New
Mexico.SJH provides a full range of care from facilities including
14 acute care hospitals, home health agencies, hospice care,
outpatient services, skilled nursing facilities, community clinics,
and physician organizations.SJH maintains a 'continuum of care,'
matched to the diverse needs of the urban centers, smaller cities
and rural communities in three statesFor the third year in a row in
2009, the Gallup Organization awarded St. Joseph Health its highest
honor - the Great Workplace Award.SJH provides exceptional
benefits, opportunities for advancement and relocation within the
system.St. Joseph Health is comprised of four core values: Service,
Excellence, Dignity, and Justice are the guiding principles of all
we do.Excellent compensation program and benefits provided.St.
Joseph Health (SJH) provides equal employment opportunities (EEO)
to all employees and applicants for employment without regard to
race, color, religion, sex, national origin, age, disability or
genetics.In addition to federal law requirements, St. Joseph Health
(SJH) complies with applicable state and local laws governing
nondiscrimination in employment in every location in which the
company has facilities.This policy applies to all terms and
conditions of employment, including recruiting, hiring, placement,
promotion, termination, layoff, recall, transfer, leaves of
absence, compensation and training.Positions specified as on call,
per diem refers to employment consisting of shifts scheduled on as
as needed basis to fill in for staff vacancies.Company: SJH System
OfficeCategory: Clinical Informatics
Keywords: St. Joseph Health / Covenant Health, Orange , Revenue Nurse Auditor-E - PSJH, Accounting, Auditing , Orange, California
Didn't find what you're looking for? Search again!