Job Description

Location: Chicago, IL

Hospital: RUSH University Medical Center

Department: Revenue Cycle Revenue Integrit

Work Type: Full Time (Total FTE between 0.9 and 1.0)

Shift: Shift 1

Work Schedule: 8 Hr (8:00:00 AM - 4:30:00 PM)

Summary:

The Revenue Integrity Nurse Auditor position will use an eye for detail, collaboration, assessments, training skills, and clinical knowledge to ensure that patient charges are accurate. In a hybrid/remote setting, the Revenue Integrity Nurse Auditor reviews charges and clinical documentation, performs outside payor defense audits initiates and leads performance improvement efforts related to charge accuracy. This role investigates and replies to patient inquiries about charges, and educates clinical departments about charging while promoting revenue integrity. In addition to reactive audits, this nurse will proactively review for charging accuracy. This nurse exemplifies the Rush mission, vision and values and acts in accordance with Rush policies and procedures.

Other information:

Required Job Qualifications:

• Current State of Illinois RN Licensure

• Associate or bachelor’s degree in nursing.

• Five years of clinical nursing experience using Epic software

• Mathematical skills related to pharmaceutical dose and unit calculations.

• Understanding of clinical charging, codes, and modifiers.

• Demonstrated ability to communicate clearly and effectively.

• Strong interpersonal skills necessary for the communication and training of Revenue Integrity concepts

• Ability to perform multiple tasks with excellent time management skills.

• Proficient in Microsoft Office, Excel, PowerPoint, and Word skills

Preferred Job Qualifications:

• Experience with Epic work queues, CPT/HCPCS codes, UB-04 Revenue Codes, Modifiers, and NCCI edits.

• Charge audit or finance-related experience.

• AHIMA or AAPC Certification (CCS, CCA,, CPC, COC, CPMA, RHIT or RHIA).

• Epic Software Certification

Physical Demands: (HR- please insert typical for desk/computer position)

Disclaimer: The above is intended to describe the general content of and requirements for the performance of this job. It is not to be construed as an exhaustive statement of duties, responsibilities or requirements.

Responsibilities:

1. Connects the clinical operations and c to any type of charge (facility or professional) for all Rush patients.

2. Understands and can use critical thinking to apply Revenue Integrity principles, charge description master (CDM), charge capture and metrics to ensure accurate charges,

3. Improves patient experience and revenue results by optimizing and improving the clinical, operational, and revenue integrity processes related to patient charges.

4. Works in patient accounts to add, edit, and delete charges, codes, modifiers related to chargeable services, supplies, devices, implants, and pharmaceuticals.

5. Reviews CPT/HCPCS descriptions and charges with clinical documentation to ensure compliant charging.

6. Represents Rush in third-party charge and defense audits and substantiates claims with documentation.

7. Responds to patient and customer service questions related to charges after researching and assessing documentation and charges.

8. Proactively perform charge and documentation reviews in coordination with Office of Inspector General (OIG) and Center for Medicare Medicaid Services (CMS) standards for accuracy.

9. Builds relationships within the revenue cycle and engages clinical areas of the organization that serve as mutually beneficial partnerships to promote accurate charges.

10. Identifies services performed in the patient documentation that need to be built in the Charge Description Master (CDM)or be charged on a patient’s account based on CPT/HCPCS descriptions compared to clinical activities.

11. Identifies chargeable supplies, implants, devices, and pharmaceuticals within the provider documentation along with understanding associated codes and appropriate use of the codes.

12. Proactively

13. Identifies and trouble-shoots charging, CDM, or clinical documentation issues and works with ancillary departments to resolve.

14. Keeps accurate records of charge audit requests, results, and remediation.

15. Provides recommendations on cost-containment related to charges, for clinical areas.

16. Contributes to internal controls to ensure compliance with charging regulations.

17. Serves as a clinical resource and subject matter resource (SME) for Revenue Cycle teammates.

18. Works collaboratively with clinical staff, operations, ancillary departments, teammates, and vendors

19. Represent Rush with legal billing and pricing inquiries related to patient litigation.

20. Identifies patterns, trends, variances, and opportunities to improve charging accuracy.

21. Engages in development and growth in the Revenue Integrity Nurse Auditor specialty.

Rush is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.

Position Rev Integrity RN Auditor

Location US:IL:Chicago

Req ID 10034