Description

Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.

Summary:
The Recovery Audit Nurse will work closely with other Business Office staff members to assist in facilitating: 1) clinically related reviews of patient accounts/claims to ensure compliant billing guidelines (internal and external) are followed (including, but not limited to Discharge Disposition, Medicare 3-Day Rule, and Outpatient Facility-based Infusion and Hydration charging), 2) reviews and follow up of claims denied by insurance companies with primary focus on managed-care and commercial payers (will work closely with Case Management / Utilization Review staff), and 3) reviews and appeals for hospital patient accounts/claims denied payment through retrospective or prospective review, i.e. - Medicare and Medicaid RA (Recovery Auditor) programs.

Responsibilities:

• Ensuring compliant billing guidelines
  
• Assistance with hospital denial management program
  
• Assistance with hospital audit response program
  
• Organizational leadership skills
  
• Collaboration and communication
  
• Performs other duties as needed

Other information:

Education Requirements:
* Associate's degree in Nursing. Bachelor of Science in Nursing preferred.
Licensure/Certification Requirements:
* RN Licensed to work as a Registered Nurse in the state of North Carolina.

• Certification in Case Management and/or Utilization Review preferred

Professional Experience Requirements:

* Requires 2-3 years of Healthcare/Medical setting

• 1 year of HealthCare/Medical - Case Manager in Case Management, UR, Hospital Billing, Compliance, Charge Capture or equiv. combo of education/experience

Legal Employer: Nash Hospitals

Entity: Nash UNC Health Care

Organization Unit: NGH Revenue Integrity

Work Type: Full Time

Standard Hours Per Week: 40.00

Work Schedule: Day Job Monday-Friday 1st shift

Location of Job: NASH HC

Exempt From Overtime: Exempt: Yes