Licensed Vocational Nurse Auditor Revenue Integrity
CHRISTUS Santa Rosa
CHRISTUS SR Ministry Administration Office Loop 410
100 NE Loop 410
San Antonio, TX 78216
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The Revenue Integrity Nurse Auditor is responsible for reviewing medical records to determine whether documentation sustains the medical necessity, quality of care, utilization and coding of insurance claims. This position insures that data collection for reporting purposes from various departments is within charging practices and departmental policies. Duties include reviewing remittance advices for denials and the appeals process, analyzing late charges, performing education and training to clinical departments and finalizing department audit summaries. The Revenue Integrity Nurse Auditor ensures optimal billing methods that meet with billing regulatory and compliance standards. This position also serves as back up to the Revenue Integrity Coordinator for purpose of charge master compliance. Serves as an integral member to the Regional Revenue Integrity Department and assists with the direction and facilitation of the group.
·LVN or RN certification required.
·Must have extensive knowledge of Federal, State and local insurance guidelines and rules.
·Intermediate to Advanced level knowledge of Microsoft Word, Excel.
·Ability to work and communicate effectively at all corporate and facility levels.
·Ability to independently prioritize work activities and to meet deadlines.
·Strong quantitative and analytical ability.
·Demonstrate ability to understand and contribute in all areas related to revenue cycle, compliance and reimbursement.
·Excellent interpersonal, problem solving and critical thinking skills.
·A minimum of 3-5 years in clinical or ancillary departmental experience required in an acute setting.
·Strong knowledge of DRG, CPT, CDM and billing operations required.
·Overall knowledge of UR and Case Management functions required.
·Chart billing and auditing experience required.
·Current Texas License- LVN or RN