Revenue Recovery RN

UCHealth • Full-time • Denver, CO, US • $37 - $57 / hour • 3w ago

Description

Location: UCHealth UCHlth Admin Lowry, US:CO:Denver; This position can be located in Southern Colorado, Denver/Metro, or Norther Colorado; candidate must reside in Colorado.

Department: UCHlth Denials Mgt Payer Audit

FTE: Full Time, 1.0, 80.00 hours per pay period (2 weeks)

Shift: Days

Pay: $37.06 - $57.44 / hour. Pay is dependent on applicant's relevant experience

Summary

Recovers potential loss in revenue due to payor denials or defense audits. Facilitates accurate reimbursement through appeal writing, conducts chart review of charge capture to documentation, and provides feedback for process opportunities.

Responsibilities

Writes clinical appeals to payors to recover denials. Coordinates with payors to conduct RN reviews and facilitates MD to MD peer reviews as necessary. Applies payor specific clinical criteria to review and determine the appropriate level of care. Participates in payor defense audits.
Reviews charts to determine if charges support the documentation. Assesses line item overcharges, undercharges, and late charges. Tracks all audit findings. Communicates opportunities to mitigate audit risk. Resolves customer service and employee issues, utilizing proactive intervention.
Coordinates new or revised procedures and policies. Analyzes process effectiveness; recommends changes as appropriate. Maintains knowledge of Federal, State and local billing regulations and partners with Managed Care contracting or compliance department on discrepancies.
Maintains knowledge of ADT, registration and pre-admit/admit processes. Maintains knowledge of contracts, billing, follow up, and cash applications processes.
Within scope of job, requires critical thinking skills, decisive judgement and the ability to work with minimal supervision. Must be able to work in a fast-paced environment and take appropriate action.

Requirements

Graduate of an accredited or state board of nursing approved Registered/Professional Nursing program if less than 3 years experience.
CO State licensure as a Registered Nurse (RN).
3 years of clinical experience as a RN, including 1 year in acute care.
1 year as a utilization reviewer, case manager or equivalent revenue cycle RN role.

Preferred

Bachelor's degree in Nursing.
CPHM, CCM, ACM.

We improve lives. In big ways through learning, healing, and discovery. In small, personal ways through human connection. But in all ways, we improve lives.

UCHealth invests in its Workforce.

UCHealth offers a Three Year Incentive Bonus to recognize employee's contributions to our success in quality, patient experience, organizational growth, financial goals, and tenure with UCHealth. The bonus accumulates annually each October and is paid out in October following completion of three years' employment.

UCHealth offers their employees a competitive and comprehensive total rewards package:

Medical, dental and vision coverage including coverage for eligible dependents
403(b) with employer matching contributions
Time away from work: paid time off (PTO), paid family and medical leave (inclusive of Colorado FAMLI), leaves of absence; start your employment at UCHealth with PTO in your bank
Employer-paid basic life and accidental death and dismemberment coverage with buy-up coverage options
Employer paid short term disability and long-term disability with buy-up coverage options
Wellness benefits
Full suite of voluntary benefits such as flexible spending accounts for health care and dependent care, health savings accounts (available with HD/HSA medical plan only), identity theft protection, pet insurance, and employee discount programs
Education benefits for employees, including the opportunity to be eligible for 100% of tuition, books and fees paid for by UCHealth for specific educational degrees. Other programs may qualify for up to $5,250 pre-paid by UCHealth or in the form of tuition reimbursement each calendar year

Loan Repayment

UCHealth is a qualifying employer for the federal Public Service Loan Forgiveness (PSLF) program! UCHealth provides employees with free assistance navigating the PSLF program to submit their federal student loans for forgiveness through Savi.

UCHealth always welcomes talent. This position will be open for a minimum of three days and until a top applicant is identified.

UCHealth recognizes and appreciates the rich array of talents and perspectives that equal employment and diversity can offer our institution. As an equal opportunity employer, UCHealth is committed to making all employment decisions based on valid requirements. No applicant shall be discriminated against in any terms, conditions or privileges of employment or otherwise be discriminated against because of the individual's race, color, national origin, language, culture, ethnicity, age, religion, sex, disability, sexual orientation, gender, veteran status, socioeconomic status, or any other characteristic prohibited by federal, state, or local law. UCHealth does not discriminate against any qualified applicant with a disability as defined under the Americans with Disabilities Act and will make reasonable accommodations, when they do not impose an undue hardship on the organization.

Who We Are (uchealth.org)

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