Revenue Integrity Nurse Auditor
GENERAL PURPOSE OF JOB: The Revenue Specialist Nurse must have an understanding of the Criteria used by insurance companies to determine payment. The must have a knowledge of billing and coding practices, and the ability to interpret clinical material to ensure criteria is met for all patient types.

The Reimbursement Specialist Nurse is a liaison between the hospital and the third party revenue department. They are responsible for reviewing all denials sent by the third party, the liaison with the RAC (or any governmental audit agency), and writing appeals based on the hospitals behalf. They must have communication and computer skills, in dealing with other departments, excel, and other computer programs. Has to be able to recognize trends with insurance companies.
ThomasMemorialHospitalreserves the right to change job duties or responsibilities as the need arises. The employee will perform other similarly related duties as assigned by the supervisor. This job description is not intended to be all-inclusive. This job description does not constitute a written or implied contract of employment.

QUALIFICATION REQUIREMENTS:

Education and/or Experience: RN license required. Preferred experience in case management or familiarity with instruments used from insurance companies to decide

Communication Skills: Conciseverbal and written communication skills are required.

Reasoning Ability: Self-starter with the ability to learn quickly and cope with a high stress area including handling emergency situations.

Computer/Typing/Mathematical Skills: Must have knowledge and functional operation of computer, fax machine, and copy machine. Will train on use of scanner, electronic signature pads and credit card machines. Must type 25 words per minute.

PHYSICAL DEMANDS:

VISUAL ACUITY, HEARING ACUITY AND MANUAL DEXTERITY

Work is clerical in nature. Must be able to lift 35 pounds or less to change paper in printers. Must be able to transport patient via wheelchair carrying an average of 150 pounds. Vision and hearing essential in communicating to the patient pertinent information as it relates to forms that must be completed at the time of registration, i.e., Living Will, Medical Power of Attorney, Privacy Notice and various insurance forms. Must be able to access entire hospital, must be able to position, move and transfer patients. Must have manual dexterity to handle printers. Must be able to stoop and pick up objects from the floor without restrictions (printer paper, etc.) Must be able to work minimum of 40 hours per week with rotation of holidays and weekends or various shifts when needed.

WORK ENVIRONMENT:

May be exposed to infections and contagious diseases. Occasional pressure to do multiple tasks and inquiries.

AGE APPROPRIATENESS:

The employee must be able to communicate with individuals of varying ages and developmental skills.

CONTINUING EDUCATION:

(OSHA) Orientation/Continuing Education:
Hospital Wide:
Initial Orientation
Employee will receive information regarding OSHA/Universal Precautions during Employment Orientation.
Continuing Education regarding OSHA/Universal Precautions will be provided in accordance with the policy entitled Educational Guidelines.

Department Specific: