Appeals RN, Hospital Charge Audit

Change Healthcare
Full time
Healthcare
United States
Hiring from: Anywhere

Appeals RN, Hospital Charge Audit 


Transforming the future of healthcare isn’t something we take lightly. It takes teams of the best and the brightest, working together to make an impact.

As one of the largest healthcare technology companies in the U.S., we are a catalyst to accelerate the journey toward improved lives and healthier communities.

Here at Change Healthcare, we’re using our influence to drive positive changes across the industry, and we want motivated and passionate people like you to help us continue to bring new and innovative ideas to life.


If you’re ready to embrace your passion and do what you love with a company that’s committed to supporting your future, then you belong at Change Healthcare.

Pursue purpose. Champion innovation. Earn trust. Be agile. Include all.

Empower Your Future. Make a Difference.


Our Hospital Charge Audit Team works on behalf of payers to audit percent of charge reimbursed claims at acute care facilities. These are not medical necessity or DRG audits


The primary focus of the Appeals RN is to produce appeal responses to providers where the provider has appealed an audit completed by our team. This will involve reviewing the appeal presented by the provider, potentially updating audit findings, and clearly communicating our position in an appeal response.


Location: Remote/Telecommuter position. This role may be remote/telecommute from any state or may be located in our Lombard IL office


Responsibilities:



  • Perform appeals effectively and timely to meet client contractual turnaround times

  • Effectively interact and communicate with team members regarding all steps of the appeals

  • Participate as needed in team meetings, client meetings and/or provider meetings wherein nursing, policy and appeals expertise is required

  • Utilize nursing knowledge in conjunction with payer policies and CMS guidelines to appropriately review and respond to provider appeals and/or give guidance to audit staff

  • Provide written and verbal clinical rationale for appeal response

  • Responsible for facilitating auditor and team member feedback

  • Communicate with audit staff and triage team as need to discuss audit outcomes and potential for audit in selected claims and facilities

  • Other duties as assigned


Minimum Requirements:



  • Two years of clinical experience in an acute care hospital


Education:



  • Graduate of an accredited College or University

  • Current R.N. license required


Critical Skills:



  • 2+ year’s experience in Hospital Charge Audit, and Provider defense audit

  • 2+ year’s experience working with Payer reimbursement policies and or CMS guidelines interpretation

  • Knowledge of acute hospital billing requirement including UB-04s, revenue codes, itemization of charges, CPT codes, HCPCS codes ICD 9/10 diagnosis and procedure codes

  • Must possess strong skills in Microsoft office programs (Word, Excel, Outlook specifically). This individual will spend most of the workday in these programs

  • Excellent organizational skills with a strong focus on attention to detail

  • Ability to follow up and resolve issues in a timely manner

  • Excellent critical thinking/problem solving skills

  • Excellent verbal and written communication skills

  • Ability to work independently as well as recognize when office support is needed

  • Ability to multi-task in a fast-paced environment

  • Ability to organize, plan, prioritize and complete assignments within the required time frame


Preferred Skills:



  • Medical coding designations including but not limited to: CCS, CPC, COC, RHIT


Physical requirements



  • General office requirements; The ability to sit at a desk, computer and use telephone for extended periods of time

  • If located near Lombard, IL office, no travel should be required

  • If located out of area, travel for orientation/training as well as up to twice per year for team meetings

  • Employees in roles that require travel will need to be able to qualify for a company credit card or be able to use their own personal credit card for travel expenses and submit for reimbursement

  • Join our team today where we are creating a better coordinated, increasingly collaborative, and more efficient healthcare system!


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