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RN Clinical Billing Auditor Remote

Company: SCL Health
Location: Broomfield
Posted on: November 9, 2019

Job Description:

YOU.



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.



US.



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.



WE.



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 learn.



YOUR DAY.



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.



YOUR EXPERIENCE.



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 setting, preferred



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 first place.



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 activities

Keywords: SCL Health, Broomfield , RN Clinical Billing Auditor Remote, Healthcare , Broomfield, Colorado

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