RN Auditor Clinical Appeals and Charge Capture
- Requisition ID
- 01 - Days
- Clinical Denials
- Support Services
- Position Type
- Regular Full-Time
- Physical Work Location and New Employee Orientation Location : Address
- 2500 W UTOPIA
- Work Hours
- 7:00am - 3:30pm
HonorHealth is a non-profit, local healthcare organization known for community service and outstanding medical quality. HonorHealth encompasses five acute care hospitals with approximately 11,500 employees and 4,500 volunteers, over 70 primary and specialty care practices, clinical research, medical education, an inpatient rehabilitation hospital, an Accountable Care Organization, two foundations, and extensive community services.
HonorHealth is a leader in medical innovation, talent and technology with a genuine commitment to your growth. The health system's vibrant careers take place in an environment filled with opportunity and respect because we see the HONOR in you.
Associate's Degree Graduate from an accredited NLN/CCNE institution Required
2 years RN experience Required
Licenses and Certifications
Nursing\RN - Registered Nurse - State Licensure And/Or Compact State Licensure Required
Performs post payment clinical auditing in defense of hospital charges. This position audits patient records to evaluate medical necessity and charge capture in an effort to minimize hospital losses; conducts requested audits to ensure consistency between medical records documentation and billing statements on patient accounts; submits appeals to payers on patient account denials when appropriate; reviews medical records and other patient documents as needed to support hospital departments; and communicates findings to appropriate departments
- Responsible for conducting reviews and responding to insurance denials. Writes concise, factual letters and provides medical record documentation to support appeal. Effectively communicates verbally with external and internal customers to ensure argument for appeal is clearly presented. Prioritizes and organizes own work to meet appeals and grievance deadlines. Responsible for the denials process, including subsequent appeal to health insurance.
- Performs charging and documentation audits on selected accounts as part of Scottsdale Healthcare’s audit and compliance plan. Reviews for completeness of documentation based on charges. Reviews charges for completeness and accuracy based on documentation. Determines if charges supported by documentation have been missed.
- Maintains timely data entry into MIDAS denial tracking software and workflow processing, to ensure an accurate denial log of all cases.
- Demonstrates awareness of departmental charging procedures and serves as a liaison between department managers and Patient Financial Services. Demonstrates awareness of payer specific reimbursement methodologies and payer specific policies and procedures regarding charging, coding, billing, claim processing, and dispute resolution to assist patients and employees of Scottsdale Healthcare. Assists and educates patient representatives regarding pricing questions and item descriptions as needed to increase efficiency.
- Performs patient inquiry audits as requested. Provides audit results and written explanation of line items (if needed) to the patient representative or supervisor. Meets with patients and corresponds electronically, telephonically, and by mail to assist with understanding of services, pricing, and the myriad of payer specific policies and procedures that impact them financially.
It is the policy of HonorHealth to provide equal opportunity in employment. Selection and employment of applicants will be made on the basis of their qualifications without regard to race, color, religion, creed, national origin, age, disability, sexual orientation, marital status, veteran status or any other legally protected status.
Please review the Equal Employment Opportunity poster.
Please review the Equal Employment Opportunity Poster.HonorHealth wants all interested and qualified candidates to apply for employment opportunities. If you are an applicant with a disability who is unable to use our online tools to search and apply for jobs, please contact us at EmploymentOffice@HonorHealth.com . Please indicate the specifics of the assistance needed. This option is reserved only for individuals with disabilities that are unable to use the online tools and is not intended for other purposes.