Revenue Integrity Nurse Auditor

Nursing Support (NS) IV

Purpose: Work Remote Position

The Nursing Support (NS) colleague (uncertified, certified, unlicensed, or licensed) provides safe, quality health care services & / or assistance to patients under the supervision & direction of a registered nurse or other designated health care professional in accordance with level of experience, education, policies & procedures.

Note: "patients" refers to patients, clients, residents, participants, customers, members

Essential Functions:

• Our Trinity Health Culture: Knows, understands, incorporates & demonstrates our Trinity Health Mission, Values, Vision, Actions & Promise in behaviors, practices & decisions.
• Work Focus: Performs clinical care activities (direct or indirect) for patients within the "scope of practice" laws & training received; Cares for patients safely by assisting in clinical care services or engaging in administrative activities (e.g., maintaining records or supplies) that enhance or improve coordination, preparation & flow of the care experience.
• Process Focus: Knows, understands & incorporates basic or essential area of practice (document, coordinate, communicate) & training standards.
• Communication: Uses clear, effective, respectful language & communication methods / means.
• Environment: Performs work in a safe, engaging, & supportive manner; Influences the responsible use of resources; Accountable for continuous self-development & supporting the growth of others.
• Maintains a working knowledge of applicable federal, state & local laws/regulations, Trinity Health Integrity & Compliance Program & Code of Conduct, as well as other policies, procedures & guidelines in order to ensure adherence in a manner that reflects honest, ethical & professional behavior & safe work practices.
• Functional Role (not inclusive of titles or advancement career progression): NS IV licensed : Licensed role (direct or indirect healthcare); Provides nursing interventions or clinical knowledge application in decision-making; Participates in the planning, implementation & / or evaluation of & solutions for care; Performs delegated focused / holistic care autonomously according to care plan; May administer medication & carry out the therapeutic treatment within scope of license (state & TH policy); Performs direct & essential care or supportive activities as part of an interdisciplinary team with a deeper understanding, including theoretical knowledge; Demonstrates a level of independence to perform activities with general oversight, through personal contributions, teamwork & initiatives to safely improve outcomes; Advocates for patients & informs / counsels patients & families about illness & care details; May serve as a knowledge resource, role model & mentor or lead / coordinate / supervise direct & essential care activities or role-based service responsibilities of unlicensed / licensed / certified healthcare professionals within licensed scope of practice.
• (Pay Range: $31.8795-$47.8193)
• Minimum Qualifications:
• High school diploma or GED; Completion of an accredited program associated with license. License in the applicable state(s) of engagement. Valid driver's license where required by assignment.
• Additional Qualifications (nice to have):
• Registered Nurse, preferred
• Training or experience according to assignment area
• Nursing Support (NS) IV
• Physical & Mental Requirements & Working Conditions (General Summary):
• Exposure to conditions which may be considered unpleasant to sight, touch, sound & / or smell. Occasional
• Exposure to fumes, odors, dusts, mists & gases, biohazards / hazards (mechanical, electrical, burns, chemicals, radiation, sharp objects, etc.). Occasional
• Exposure to or subject to noise, infectious waste, diseases & conditions. Occasional
• Exposure to interruptions, shifting priorities & stressful situations. Frequent
• Ability to follow tasks through to completion, understand & relate to complex ideas / concepts, remember multiple tasks & regimens over long periods of time & work on concurrent tasks / projects. Frequent
• Ability to read small print, hear sounds & voice / speech patterns, give / receive instructions & other verbal communications (in-person & / or over the phone / computer / device / equipment assigned) with some background noise. Frequent
• Perform manual dexterity activities & / or grasping / handling. Continuous
• Ability to climb, kneel, crouch & / or operate foot controls. Occasional
• Use a computer / other technology. Frequent
• Sit with the ability to vary / adjust physical position or activity. Frequent
• Maintain a safe working environment & use available personal protective equipment (PPE). Continuous
• Comply with Trinity Health's Code of Conduct, policies, procedures & guidelines. Continuous
• Ability to provide assistance in the event of an emergency. Occasional
• Direct Healthcare Services:
• Perform activities that require standing / walking with the ability to vary / adjust physical position or activity. Occasional
• Lift a maximum of 30 pounds unassisted. Occasional
• Use upper & lower extremities, engage in bending / stooping / reaching & pushing / pulling. Occasional
• Work indoors (subject to travel requirements) under temperature-controlled & well-lit conditions. Continuous
• Encounter worksites (e.g., patient homes) or travel to worksites that may have variable internal & external environmental conditions. Occasional
• Perform work that involves physical efforts (e.g., transporting, moving, positioning & / or ambulating patients). Occasional
• Indirect Healthcare / Support Services:
• Perform activities that require standing / walking with the ability to vary / adjust physical position or activity. Occasional
• Lift a maximum of 30 pounds unassisted. Occasional
• Experience of long periods of walking / standing / stooping / bending / pulling & / or pushing. Occasional
• Encounter a clinical / patient facing / hands on interactive work environment. Occasional
• Work indoors (subject to travel requirements) under temperature-controlled & well-lit conditions. Continuous
• Work outdoors with variable external environmental conditions. Occasional
• Average Workday Activity: Occasional - O (1% - 33%), Frequent - F (34% - 66%), Continuous - C (67% - 100%)
• (Pay Range: $31.8795-$47.8193)
• Nursing Support (NS) IV
• Addendum
• Additional minimum qualifications:
• Four (4) + years of nursing experience
• Must possess a demonstrated knowledge of revenue cycle & denial management functions.
• Knowledge of & experience in case management & utilization management.
• Customer service background is required.
• Additional Preferred qualifications:
• Registered Nurse, preferred.
• Bachelor's degree, preferred.
• Two (2) + years of charge audit, managed care or comparable patient payment processing experience preferred.
• AAPC, AHIMA, CHRI certification/membership strongly preferred.
• Outpatient CDI experience preferred.
• Working knowledge of Electronic Health Records (EHR), preferred
• Responsible for coordinating revenue integrity/ charge-related denials with Patient Business Service (PBS) center & ensures compliant & complete clinical documentation, assists with denials & related audits & identifies opportunities for revenue optimization.
• Performs thorough and routine chart reviews, providing education to clinical colleagues & tracking of identified trends.
• Leverages clinical knowledge & standard procedures to ensure timely attention to charge-related trends and provides necessary education to responsible party.
• Responsible for retrospective charge reviews & assistance with third party charge audits. May require travelling between locations within the region.
• Ensures tracking of all Revenue Integrity- related audits, identifying trends & collaborating with other Revenue Integrity, PBS & /or departmental colleagues on education & reporting to key stakeholders.
• Serves as a resource contact, providing clinical information as requested by intra & inter-departmental colleagues & payers.
• Collaborates with Revenue Integrity team on opportunities to improve & implement front-end