RN Nurse Auditor - Telecommute in IN or

Employment Type: Full time Shift:

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
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.
Knows, understands & incorporates basic or essential area of practice (document, coordinate, communicate) & training standards.
Communication: Uses clear, effective, respectful language & communication methods / means.
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.
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.
​(High school diploma or GED; Registered Nurse, preferred
Training or experience according to assignment area
Nursing Support (NS) IV
Direct Healthcare Services / Indirect Healthcare / Support Services:
Exposure to fumes, odors, dusts, mists & gases, biohazards / hazards (mechanical, electrical, burns, chemicals, radiation, sharp objects, etc.). Exposure to or subject to noise, infectious waste, diseases & conditions. Exposure to interruptions, shifting priorities & stressful situations. 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. 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. Use a computer / other technology. Sit with the ability to vary / adjust physical position or activity. Maintain a safe working environment & use available personal protective equipment (PPE). Comply with Trinity Health’s Code of Conduct, policies, procedures & guidelines. Ability to provide assistance in the event of an emergency. Direct Healthcare Services:
Perform activities that require standing / walking with the ability to vary / adjust physical position or activity. Work indoors (subject to travel requirements) under temperature-controlled & well-lit conditions. patient homes) or travel to worksites that may have variable internal & external environmental conditions. Indirect Healthcare / Support Services:
Perform activities that require standing / walking with the ability to vary / adjust physical position or activity. Encounter a clinical / patient facing / hands on interactive work environment. Work indoors (subject to travel requirements) under temperature-controlled & well-lit conditions. Work outdoors with variable external environmental conditions. Average Workday Activity: Nursing Support (NS) IV
Four (4) + years of nursing experience
Knowledge of & experience in case management & utilization management.
Customer service background is required.
Registered Nurse, preferred.
Bachelor’s degree, preferred.
Two (2) + years of charge audit, managed care or comparable patient payment processing 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.
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 process to support denial prevention.
By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.