Registered Nurse - Auditor Clinical Appeals Charge Capture

Remote. Must reside in the State of Arizona.

Overview

Looking to be part of something more meaningful? At HonorHealth, you’ll be part of a team, creating a multi-dimensional care experience for our patients. You’ll have opportunities to make a difference. From our Ambassador Movement to our robust training and development programs, you can select where and how you want to make an impact. HonorHealth offers a diverse benefits portfolio for our full-time and part-time team members designed to help you and your family live your best lives. Visit honorhealth.com/benefits to learn more. Join us. Let’s go beyond expectations and transform healthcare together. HonorHealth is one of Arizona’s largest nonprofit healthcare systems, serving a population of five million people in the greater Phoenix metropolitan area. The comprehensive network encompasses six acute-care hospitals, an extensive medical group with primary, specialty and urgent care services, a cancer care network, outpatient surgery centers, clinical research, medical education, a foundation, an accountable care organization, community services and more. With nearly 17,000 team members, 3,700 affiliated providers and close to 2,000 volunteers dedicated to providing high quality care, HonorHealth strives to go beyond the expectations of a traditional healthcare system to improve the health and well-being of communities across Arizona. Learn more at HonorHealth.com.

Responsibilities

Job Summary Performs post payment clinical auditing in defense of hospital charges. This position audits patient records to evaluate medical necessity and charge capture in an effort to minimize hospital losses; conducts requested audits to ensure consistency between medical records documentation and billing statements on patient accounts; submits appeals to payers on patient account denials when appropriate; reviews medical records and other patient documents as needed to support hospital departments; and communicates findings to appropriate departments Essential Functions

• Responsible for conducting reviews and responding to insurance denials. Writes concise, factual letters and provides medical record documentation to support appeal. Effectively communicates verbally with external and internal customers to ensure argument for appeal is clearly presented. Prioritizes and organizes own work to meet appeals and grievance deadlines. Responsible for the denials process, including subsequent appeal to health insurance.
• Performs charging and documentation audits on selected accounts as part of HonorHealth’s audit and compliance plan. Reviews for completeness of documentation based on charges. Reviews charges for completeness and accuracy based on documentation. Determines if charges supported by documentation have been missed.
• Maintains timely data entry into MIDAS denial tracking software and workflow processing, to ensure an accurate denial log of all cases.
• Demonstrates awareness of departmental charging procedures and serves as a liaison between department managers and Patient Financial Services. Demonstrates awareness of payer specific reimbursement methodologies and payer specific policies and procedures regarding charging, coding, billing, claim processing, and dispute resolution to assist patients and employees of HonorHealth. Assists and educates patient representatives regarding pricing questions and item descriptions as needed to increase efficiency.
• Performs patient inquiry audits as requested. Provides audit results and written explanation of line items (if needed) to the patient representative or supervisor. Meets with patients and corresponds electronically, telephonically, and by mail to assist with understanding of services, pricing, and the myriad of payer specific policies and procedures that impact them financially.

Education

• Bachelor's Degree Graduate from an accredited NLN/CCNE institution - Preferred
• Associate's Degree Graduate from an accredited NLN/CCNE institution - Required

Experience

• 2 years RN experience - Required

Licenses and Certifications

• NursingRN - Registered Nurse - State Licensure And/Or Compact State Licensure - Required

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