Registered Nurse Audit
Full Time Days Remote
Why UT Southwestern? With over 75 years of excellence in Dallas-Fort Worth, Texas, UT Southwestern is committed to excellence, innovation, teamwork, and compassion. As a world-renowned medical and research center, we strive to provide the best possible care, resources, and benefits for our valued employees. Ranked as the #1 hospital in Dallas-Fort Worth for the eighth consecutive year, we invite you to continue your healthcare career with us at William P. Clements Jr. University Hospital. You’ll discover a culture of teamwork, professionalism, and consistent opportunities for learning and advancement into leadership roles.
Job Summary
Prepare for and conduct audits requested by governmental and managed care payers, comparing clinical documentation to charges billed to identify any possible under/over charges; documents and sends audit results to payer organizations or external auditors for review and resolution as applicable; maintains communication with auditors and other relevant individuals/organizations until all discrepancies are resolved.
Experience and Education
Graduate of an accredited nursing program with a current license to practice in the state of Texas. Certification as RN.
Revenue Integrity experience strongly preferred.
OR Audit experience preferred.
Five (5) years of clinical experience as a Registered Nurse, including at least 2 years performing utilization review, charge audit, case management or denial/appeal functions in an acute care hospital.
Principles of Managed Care, Medicare/Medicaid reimbursement required.
Job Duties
• Prepare for and conduct audits requested by governmental and managed care payors, comparing clinical documentation to charges billed to identify any possible under/over charges; documents and sends audit results to payor organizations or external auditors for review and resolution as applicable; maintains communication with auditors and other relevant individuals/organizations until all discrepancies are resolved.
• Performs internally defined audits to identify under/over charges; reviews charges posted to the claims against the necessary clinical documentation to identify any possible under/over charges; documents audit findings and sends results to appropriate departments.
• Performs charge audits as requested by patients; reviews billed charges for patients who are disputing charges by comparing the charges against all necessary clinical documentation and looking for discrepancies; documents audit results; posts corrections to accounts; communicates back to appropriate departments and sends to PFS/Customer Service for rebilling if necessary.
• Conducts review of accounts that have not been paid according to their contractual agreement because of denied charges; compares charges with clinical documentation to determine the validity of the denial and/or identifies any charge discrepancies; documents audit findings; posts adjustments to accounts and sends to appropriate department for rebilling and/or payment correction if necessary.
• Assists departments with the charge reconciliation process. Works with all relevant hospital departments to provide timely education on how to correct or improve processes that have been found to be deficient.
• Works with various staff and departments such as Health Information Management, clinical nursing units, physicians and others to obtain the information necessary to perform account audits.
• Performs other duties as assigned.
Working Conditions
This job is remote only and individuals who reside in the job will permanently work 100% from an alternate approved worksite. Any qualifications to be considered as equivalents in lieu of stated minimums require prior approval of the Vice President for Human Resources Administration, or his/her designee.
This position is security-sensitive and subject to Texas Education Code §51.215, which authorizes UT Southwestern to obtain criminal history record information.
Equal Opportunity Employer
UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. As an equal opportunity employer, UT Southwestern prohibits unlawful discrimination, including discrimination on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, gender expression, age, disability, genetic information, citizenship status, or veteran status.
Benefits
UT Southwestern is proud to offer a competitive and comprehensive benefits package to eligible employees. Our benefits are designed to support your overall wellbeing, and include:
• PPO medical plan, available day one at no cost for full-time employee-only coverage
• 100% coverage for preventive healthcare – no copay
• Paid Time Off, available day one
• Retirement Programs through the Teacher Retirement System of Texas (TRS)
• Paid Parental Leave Benefit
• Wellness programs
• Tuition Reimbursement
• Public Service Loan Forgiveness (PSLF) Qualified Employer
Learn more about these and other UTSW employee benefits!
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