Job Description:
Baptist Health is looking for a Revenue Integrity Nurse to join our team. This is a remote position that requires residency in KY or IN
Performs payor compliance review on accounts to determine medical necessity of services, pre and post service as well as pre and post billing. Obtains predeterminations / prior authorizations when required by payor. Reviews and works medical necessity denials or audits from commercial and governmental payors, including those performed by RACs or similar Medicare and Medicaid programs. Responds to all denials or payor audits with best possible efforts to recover outstanding revenue or prevent future revenue loss, meeting all appropriate payor or government timelines. Serves as clinical resource for other revenue cycle staff.
Minimum Education, Experience, Training and Licensures Required
Bachelor’s degree in a related field and two years healthcare experience in a field mentioned above
Associate degree with minimum three years healthcare experience in nursing, registration, patient financial services, managed care or a related field.
Valid Kentucky Licensure as a Registered Nurse
Geisinger
Mantra Health
University of Arkansas System
Convatec
McKesson