[Hiring] Clinical Nurse Auditor @The University of Kansas Health System

Role Description

The Clinical Nurse Auditor - Rev Cycle will work with pre-certification, authorization, and denials teams to assist in obtaining upfront authorization for services rendered. Key responsibilities include:

• Assisting with denial management and resolution.
• Collaborating with HIM, PFS, Case Management, and multiple clinical departments to resolve account problems related to authorization of services.
• Supporting the Clinical Trials business line by reviewing protocols to ensure services billed as standard of care are evidence-based and meet industry guidelines.
• Identifying all services rendered as part of clinical trials.

Qualifications

• Bachelor's Degree in Nursing.
• 2 or more years of experience in utilization review, clinical review, or authorizations.

Requirements

• Licensed Registered Nurse (LRN) - Multi-State - State Board of Nursing Current State RN license.
• EPIC experience (preferred).

Responsibilities and Essential Job Functions

• Decrease denied and inappropriately paid claims attributable to clinical and/or administrative reasons.
• Perform utilization review for correct patient setting and status.
• Review high dollar & high-risk areas like transplants, Cancer Center, and Cardiology.
• Use clinical expertise to perform ongoing reviews of medical record documentation.
• Assist in tabulations of results and reports to management.
• Support process improvement activities to assure medical record compliance.
• Collaborate with HIM coding staff and Patient Financial Services to resolve account problems.
• Monitor process effectiveness to identify trends and improvement opportunities.
• Assist with quality improvement initiatives across the continuum of care.
• Evaluate and resolve issues related to the revenue cycle.
• Assist with documentation support and issue resolution in charge capture, coding, and claim submission.
• Work with various departments and physician offices to resolve revenue cycle conflicts.
• Provide training to improve revenue cycle processes.
• Recommend policies and procedures improvements to increase efficiencies.
• Provide education and feedback to improve medical record documentation quality.
• Perform professional, clinical, and technical competencies of the assigned unit or department.

Benefits

• Equal employment opportunity employer.
• Reasonable accommodations for qualified individuals with disabilities.