Key Facts

Remote From:

Full time

English

Hard Skills

Revenue Recognition Prior Authorization Medical Necessity Revenue Management Nurse Licensure Compact Registration Medical Abbreviations Service Review Reimbursement Regulations Billing +7 more

Other Skills

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Time Management
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Teamwork
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Innovation

Roles & Responsibilities

Valid Kentucky licensure as a registered nurse
Minimum three years healthcare experience (nursing, registration, patient accounting, financial services, managed care or a related field) or a Bachelor’s Degree in a related field and two years healthcare experience
Knowledge of medical terminology; payor reimbursement guidelines (authorization / notification, medical necessity, and timely filing guidelines); payor denial appeal / underpayment resolution processes; and managed care contracts
Understanding of audit response requirements and timelines for government audits

Requirements:

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 medical necessity denials from commercial and governmental payors, including pre-denial audits performed by RACs or similar Medicare and Medicaid programs
Responds to all denials or pre-denial audits with best possible efforts to recover outstanding revenue or prevent future revenue loss, meeting all appropriate payor or government timelines

Baptist Health System KY & IN

About Baptist Health System KY & IN

Founded in 1924 in Louisville, Kentucky, Baptist Health is a full-spectrum health system dedicated to improving the health of the communities it serves. The Baptist Health family consists of nine hospitals, employed and independent physicians, and more than 400 points of care, including outpatient facilities, physician practices and services, urgent care clinics, outpatient diagnostic and surgery centers, home care, fitness centers, and occupational medicine and physical therapy clinics. Baptist Health’s eight owned hospitals include more than 2,300 licensed beds in Corbin, Elizabethtown, La Grange, Lexington, Louisville, Paducah, Richmond and New Albany, Indiana. Baptist Health also operates the 410-bed Baptist Health Deaconess Madisonville in Madisonville, Kentucky in a joint venture with Deaconess Health System based in Evansville, Indiana. Baptist Health employs more than 23,000 people in Kentucky and surrounding states. Baptist Health is the first health system in the U.S. to have all of its hospitals recognized by the American Nursing Credentialing Center with either a Magnet® or Pathway to Excellence® designation for nursing excellence. Baptist Health’s employed provider network, Baptist Health Medical Group, has nearly 1,500 providers, including more than 750 physicians and more than 740 advanced practice clinicians. Baptist Health’s physician network also includes more than 2,000 independent physicians. Learn more at BaptistHealth.com.

Company type: XLarge

Founded: 2018

Company size: 10001

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Job description

Summary

Job Description:

Baptist Health is looking for a Revenue Integrity RN to join our team! This is a remote work 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 medical necessity denials from commercial and governmental payors, including pre-denial audits performed by RACs or similar Medicare and Medicaid programs. Responds to all denials or pre-denial 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 Integrity staff.

Qualifications:

Valid Kentucky licensure as a registered nurse.
Minimum three years healthcare experience (nursing, registration, patient accounting, financial services, managed care or a related field) or a Bachelor’s Degree in a related field and two years healthcare experience.
Requires knowledge of medical terminology; payor reimbursement guidelines (authorization / notification, medical necessity, and timely filing guidelines); payor denial appeal / underpayment resolution processes; and managed care contracts. Individuals working with government audits must have a keen understanding of all audit response requirements and timelines.

Work Experience

Education