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Revenue Recovery RN

Location: Denver, CO, United States
Category: Nursing Professional
Job Type: Full Time
Job ID: 211770
Date Posted: Jul 16, 2024

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Description

Revenue Recovery RN

Location: Colorado. This may be a 100% work-from-home opportunity but you must reside in Colorado.

Department: UCHlth Denials Management Payer Audit

FTE: Full Time, 1.0, 80.00 hours per pay period (2 weeks)

Shift: Days 

Pay: $37.06 - $57.44 / hour. Pay is dependent on applicant's relevant experience

Summary:
Recovers potential loss in revenue due to payor denials or defense audits. Facilitates accurate reimbursement through appeal writing, conducts chart review of charge capture to documentation, and provides feedback for process opportunities.

Responsibilities:

  • Writes clinical appeals to payors to recover denials. Coordinates with payors to conduct RN reviews and facilitates MD to MD peer reviews as necessary. Applies payor specific clinical criteria to review and determine the appropriate level of care. Participates in payor defense audits.
  • Reviews charts to determine if charges support the documentation. Assesses line item overcharges, undercharges, and late charges. Tracks all audit findings. Communicates opportunities to mitigate audit risk. Resolves customer service and employee issues, utilizing proactive intervention.
  • Coordinates new or revised procedures and policies. Analyzes process effectiveness; recommends changes as appropriate. Maintains knowledge of Federal, State and local billing regulations and partners with Managed Care contracting or compliance department on discrepancies.
  • Maintains knowledge of ADT, registration and pre-admit/admit processes. Maintains knowledge of contracts, billing, follow up, and cash applications processes.
  • Within scope of job, requires critical thinking skills, decisive judgement and the ability to work with minimal supervision. Must be able to work in a fast-paced environment and take appropriate action.

Requirements:

  • Graduate of an accredited or state board of nursing approved Registered/Professional Nursing program if less than 3 years experience. 
  • CO State licensure as a Registered Nurse (RN).
  • 3 years of clinical experience as a RN, including 1 year in acute care.
  •  1 year as a utilization reviewer, case manager or equivalent revenue cycle RN role.

Preferred:

  • Bachelor's degree in Nursing. 
  • CPHM, CCM, ACM.

We improve lives. In big ways through learning, healing, and discovery. In small, personal ways through human connection. But in all ways, we improve lives.

UCHealth invests in its Workforce.

UCHealth offers a Five Year Incentive Bonus to recognize employee’s contributions to our success in quality, patient experience, organizational growth, financial goals, and tenure with UCHealth. The bonus accumulates annually each October and is paid out in October following completion of five years’ employment.

UCHealth offers their employees a competitive and comprehensive total rewards package:

  • Full medical, dental and vision coverage
  • Retirement plans to include 403(b) matching
  • Paid time off. Start your employment at UCHealth with PTO in your bank
  • Employer-paid life and disability insurance with additional buy-up coverage options
  • Tuition and continuing education reimbursement
  • Wellness benefits
  • Full suite of voluntary benefits such as identity theft protection and pet insurance
  • Education benefits for employees, including the opportunity to be eligible for 100% of tuition, books and fees paid for by UCHealth for specific educational degrees. Other programs may also qualify for up to $5,250 pre-paid by UCHealth or in the form of tuition reimbursement each calendar year

Loan Repayment:

  • UCHealth is a qualifying employer for the federal Public Service Loan Forgiveness (PSLF) program! UCHealth provides employees with free assistance navigating the PSLF program to submit their federal student loans for forgiveness through Savi.

UCHealth always welcomes talent. This position will be open for a minimum of three days and until a top applicant is identified.

UCHealth recognizes and appreciates the rich array of talents and perspectives that equal employment and diversity can offer our institution. As an affirmative action/equal opportunity employer, UCHealth is committed to making all employment decisions based on valid requirements. No applicant shall be discriminated against in any terms, conditions or privileges of employment or otherwise be discriminated against because of the individual's race, creed, color, religion, gender, national origin or ancestry, age, mental or physical disability, sexual orientation, gender identity, transgender status, genetic information or veteran status. UCHealth does not discriminate against any "qualified applicant with a disability" as defined under the Americans with Disabilities Act and will make reasonable accommodations, when they do not impose an undue hardship on the organization.

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