Rev Audit Contract Appeals RN

At Northwestern Medicine, every patient interaction makes a difference in cultivating a positive workplace. This patient-first approach is what sets us apart as a leader in the healthcare industry. As an integral part of our team, you'll have the opportunity to join our quest for better healthcare, no matter where you work within the Northwestern Medicine system. At Northwestern Medicine, we pride ourselves on providing competitive benefits: from tuition reimbursement and loan forgiveness to 401(k) matching and lifecycle benefits, we take care of our employees. Ready to join our quest for better?

The Rev Audit Contract Appeals RN reflects the mission, vision, and values of NM, adheres to the organization's Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines, and all other regulatory and accreditation standards.

Using clinical knowledge and evaluation of documented patient treatments, this position receives, interprets and facilitates appeals on insurance denials post payment, including payer escalation and other escalation methods to secure payment. This position is responsible for management of audits, including those from the Centers of Medicare & Medicaid Services (CMS). This position provides financial data and analysis for internal and external reporting and ensures the hospital is prepared for audits and responds to all audit requests.

AA/EOE

Required:

• Licensed Registered Nurse (Current).
• Minimum of 3 years in Acute Care Setting or in Audit/Appeals position.
• Working knowledge of Miliman/Interqual guidelines.
• Ability to analyze data; strong communication skills and ability to work cross functionally with other departments.

Preferred:

• BSN in Nursing.
• Knowledge of Medicare reimbursement policies.

Northwestern Medicine is an affirmative action/equal opportunity employer and does not discriminate in hiring or employment on the basis of age, sex, race, color, religion, national origin, gender identity, veteran status, disability, sexual orientation or any other protected status.