RN Clinical Billing Auditor Remote
Company: SCL Health
Posted on: November 9, 2019
You bring your body, mind, heart and spirit to your work as a
Clinical Billing Auditor Registered Nurse.
Youre generous with your thoughts, your partnerships and especially
your voice, because your opinion matters.
Youre great at what you do, but you want to be part of something
even greater. Because you believe that while individuals can be
strong, the right team is invincible.
System Services is our Corporate Headquarters in Broomfield,
Colorado and is located within the Oracle campus. SCL Health is a
faith-based, nonprofit healthcare organization dedicated to
improving the well-being of the people we serve.
Benefits are one of the ways we encourage health for you and your
family. Our generous package includes medical, dental and vision
coverage. But health is more than a well-working body: it
encompasses body, mind and social well-being. To that end, weve
launched a Healthy Living program to address your holistic health.
Healthy Living includes financial incentives, digital tools,
tobacco cessation, classes, counseling and paid time off. We also
offer financial wellness tools and retirement planning.
Together well align mission and careers, values and workplace. Well
encourage joy and take pride in our integrity.
Well laugh at each others jokes (even the bad ones). Well hello and
high five. Well celebrate milestones and acknowledge the value of
spirituality in healing.
Were proud of what we know, which includes how much there is to
As a Clinical Billing Auditor RN you need to know how to:
Conduct objective reviews of patient accounts when requested by
payers, audit firms, associates, or patients. Correct charges or
other information as needed to ensure accurate claims. Develop
appeals related to clinical or medical necessity denials. May act
as the primary contact for follow up and oversight of any
remediation required by audit findings.
Utilize department work queues to perform claim reviews, appeal
assessments, charge corrections, and or other account activities
which require clinical review or expertise. Utilize evidence based
practice guidelines and federal, state, local billing regulations
and/or payer guidelines including LCDs/NCDs in support of the
appeal response or other billing decisions.
Act as a liaison to payers, business partners, and associates in
coordinating and assisting with denial and appeal activities.
Attend or conduct regular meetings with care sites to review appeal
opportunities and findings.
Determine appeal response in collaboration with audit analysts,
care site audit response teams, care management, appeal assistance
business partner, corporate compliance, legal counsel, health
information management, SCL Health associates, and any others
involved in the audit response process. Communicate appeal activity
and outcomes for each care site and the system when requested.
Collaborate with Clinical Documentation Improvement (CDI), Decision
Support, Compliance Revenue Integrity and/or Care Management to
provide education based on outcomes of audits and appeals. *
Develop and provide education to clinical teams regarding
documentation requirements as needed. Monitor, analyze,
communicate, and implement new or updated requirements related to
government or other payer audits.
We hire people, not resumes. But we also expect excellence, which
is why we require:
Current RN license in state of practice, required
Minimum of three (3) years of work experience in hospital insurance
billing, utilization review or care management, third party claim
audits, or compliance and auditing in a healthcare setting,
required * At least five (5) years of work experience in hospital
insurance billing, utilization review or care management, third
party claim audits, or compliance and auditing in a healthcare
YOUR NEXT MOVE.
Now that you know more being a Clinical Billing Auditor RN on our
team we hope youll join us. At SCL Health youll reaffirm every day
how much you love this work, and why you were called to it in the
This is a remote position. *Selected candidate must be able to
train in Broomfield, CO.
Our facilities do not discriminate against any person on the basis
of race, color, national origin, disability, or age in admission or
access to, or treatment or employment in, its programs, services or
activities, or on the basis of sex (gender) in health programs and
Keywords: SCL Health, Broomfield , RN Clinical Billing Auditor Remote, Healthcare , Broomfield, Colorado
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