[Hiring] Revenue Integrity RN @BHS

Role Description

Baptist Health is looking for a Revenue Integrity RN to join our team! This is a remote work position that requires residency in KY or IN.

• Performs payor compliance review on accounts to determine medical necessity of services, pre and post service as well as pre and post billing.
• Obtains predeterminations / prior authorizations when required by payor.
• Reviews medical necessity denials from commercial and governmental payors, including pre-denial audits performed by RACs or similar Medicare and Medicaid programs.
• Responds to all denials or pre-denial audits with best possible efforts to recover outstanding revenue or prevent future revenue loss, meeting all appropriate payor or government timelines.
• Serves as clinical resource for other Revenue Integrity staff.

Qualifications

• Valid Kentucky licensure as a registered nurse.
• Minimum three years healthcare experience (nursing, registration, patient accounting, financial services, managed care or a related field) or a bachelor’s degree in a related field and two years healthcare experience.
• Requires knowledge of medical terminology; payor reimbursement guidelines (authorization / notification, medical necessity, and timely filing guidelines); payor denial appeal / underpayment resolution processes; and managed care contracts.
• Individuals working with government audits must have a keen understanding of all audit response requirements and timelines.
• Case Management and/or Inpatient nursing experience strongly preferred.

Company Description

Baptist Health is an Equal Employment Opportunity employer.