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Find our Physician, Nurse Practitioner, Physician Assistant, Medical Director and other advanced practice openings on psdconnect.org.
Find our Physician, Nurse Practitioner, Physician Assistant, Medical Director and other advanced practice openings on psdconnect.org.
Description
Providence St. Joseph Health is calling a Nurse Auditor, Revenue Cycle to work remotely within our footprint states: AK, CA, MT, OR, TX and/or WA.
The Nurse Auditor is responsible for providing patient-focused, standardized, compliant revenue cycle support that will assist Providence St Joseph Health to in meeting financial objectives.
Responsibilities:
Independently conduct revenue audits including bill audits, focus audits, compliance audits, government audits and patient requests. Gather and review all necessary clinical documentation and compare to the final edited bill. Use clinical expertise and knowledge of Medicare or payer billing requirements, to evaluate the accuracy of billed charges and hospital’s compliance with Medicare and other billing rules.
Develop, monitor, and report key measurements, trends and audit results to RI-CDM management.
Collaborate with facilities to identify minimum specifications and/or processes each need in place to support compliant and accurate clinical documentation that supports medical necessity and other regulatory requirements.
Collaborate with facilities to identify and develop needed resources to provide education and evaluation of clinical documentation.
Interpret and communicate regulatory standards and their implications to clinicians and key internal constituents.
Document and communicate recurring problems, including business impact and possible resolutions.
Take initiative in investigating and resolving claim and charging issues.
Independently address patient, department and administrative requests for a variety of issues related to revenue and charge integrity.
Reduce reporting variations by working with business office departments to identify issues impeding accurate, timely and relevant reporting.
Manage payer denials after the Hospital PFS or Case Manager identifies the denial by gathering/reviewing all necessary clinical and non-clinical documentation.
Review recommendations as subject matter expert to ensure recommendations are sustainable.
Work with RI-CDM Department and Internal Audit, providing audit related assistance as needed.
Investigate medical record and charge entry discrepancies, analyze information, and make recommendations for corrections or process improvements.
Serve as a primary revenue integrity resource and liaison for charge producing departments, RBO, HIM-Coding, Case Management and Admitting.
Required qualifications:
Associate's Degree in Nursing Or
Bachelor's Degree in Nursing Or
5 years Clinical experience in an acute care setting.
3 years Experience actively utilizing MEDITECH/EPIC and the reporting functions.
Experience working with revenue cycle team members to accomplish specific objectives.
Proven track record in identifying and resolving inefficiencies in charge capture and revenue cycle processes.
A track record in organizing and planning with demonstrated ability to effectively manage time and achieve results in a fast paced environment.
1 year Familiarity with Revenue Cycle processes.
Preferred qualifications:
Master's Degree in Nursing, Healthcare Administration, or equivalent.
3 years Working in case management or similar function in an acute care setting.
1 year Experience in a multi-hospital and/or integrated healthcare system.
Case Management Healthcare Professional upon hire
Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.
Salary Range:
NorCal (Napa, Sonoma)
Min: $43.48, Max: $70.20
Southern California, NorCal (Humboldt) Alaska (Kodiak, Seward, Valdez)
Min: $38.76, Max: $62.57
WA Puget Sound Oregon (Portland) Alaska (Anchorage)
Min: $37.18 Max: $60.03
Oregon (Hood River, Medford, Seaside)
Min: $34.66, Max: $55.96
Eastern Washington (Richland, Spokane, Walla Walla)
Min: $33.09 , Max: $53.41
Montana
Min:$25.93, Max: $48.33
Texas
Min:$28.36, Max: $45.78
About Providence
At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Check out our benefits page for more information about our Benefits and Rewards.
About the Team
Providence Shared Services is a service line within Providence that provides a variety of functional and system support services for our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.
We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment.
We are committed to cultural diversity and equal employment for all individuals. It is our policy to recruit, hire, promote, compensate, transfer, train, retain, terminate, and make all other employment-related decisions without regard to race, color, religious creed (including religious dress and grooming practices), national origin (including certain language use restrictions), ancestry, disability (mental and physical including HIV and AIDS), medical condition (including cancer and genetic characteristics), genetic information, marital status, age, sex (which includes pregnancy, childbirth, breastfeeding and related medical conditions), gender, gender identity, gender expression, sexual orientation, genetic information, and military and veteran status or any other applicable legally protected status. We will also provide reasonable accommodation to known physical or mental limitations of an otherwise qualified caregiver or applicant for employment, unless the accommodation would impose undue hardship on the operation of our business.
We are a community where all people, regardless of differences, are welcome, secure, and valued. We value respect, appreciation, collaboration, diversity, and a shared commitment to serving our communities. We expect that all workforce members in our community will act in ways which reflect a commitment to and accountability for, racial and social justice and equality in the workplace. As such, we will maintain a workplace free of discrimination and harassment based on any applicable legally protected status. We also expect that all workforce members will maintain a positive workplace free from any unacceptable conduct which creates an intimidating, hostile, or offensive work environment.
Requsition ID: 165691
Company: Providence Jobs
Job Category: Revenue Cycle Operations
Job Function: Revenue Cycle
Job Schedule: Full time
Job Shift: Day
Career Track: Nursing
Department: 4001 SS RC CHARGE DECR MSTR
Address: OR Portland 4400 NE Halsey St
Pay Range: $37.18 - $60.03
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Check out our benefits page for more information about our Benefits and Rewards.
Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.