Remote Revenue Integrity Nurse Auditor

Optum

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Requisition Number: 2191668
Job Category: Nursing
Primary Location: South Windsor, CT
(Remote considered)

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. 

Under the direction of the Enterprise Revenue Integrity Charge Audit and Optimization Manager, the Revenue Integrity Clinical Liaison will act as the liaison between the Revenue Integrity department and Information Technology Clinical Electronic Health Record (EHR) key stakeholders in support of preserving and enhancing the integrity of revenue.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. 

  

Primary Responsibilities: 

  • Works collaboratively with the Chargemaster Specialists when new CDM requests are received to assure that the charge is setup and mapped appropriately in the EHR
  • Work collaboratively with the IT key stakeholders to audit and maintain the integrity of charge code mapping within the EHR
  • Develops and maintains relationships with key stakeholders within the member organization
  • Contributes to process improvement initiatives within the enterprise revenue cycle by recognizing process improvement opportunities, anticipating and proposing opportunities, engaging stakeholders, conducting root cause analyses and developing and executing plans to achieve best practice
  • Contributes to the development and maintenance of policies and education
  • Works collaboratively with the Enterprise Revenue Integration Director
  • Works collaboratively with peers and managers to facilitate an understanding of current charge methodology, regulatory requirements and current best practices. Provides education as necessary
  • Analyzes charge capture methodologies to assess the accuracy of charge code mapping for clinical events. This includes electronic documentation, clinical orders, tasks and forms, fee tickets, charge code mapping within systems and manual processes
  • Proactively participates in IT workflow design, build, testing and go-live events to assure the accuracy of charge code generation for clinical services
  • Actively participates in issues resolution
  • Accurately translates business requirements to detail-level system specifications and evaluates against current system capabilities
  • Monitors key performance indicators and works collaboratively with member organization for optimal results
  • Investigates and resolves charge related issues.  Collaborates with peers and managers to resolve issues identified and proactively prevent charge related issues
  • Works collaboratively with peers and managers to provide feedback and education to the member organization to preserve and enhance the integrity of revenue
  • Maintains a working knowledge of industry best practices, guiding principles, regulatory mandates, and payer requirements and applies understanding in the dissemination of education.
  • Continually works to preserve and enhance the integrity of revenue
  • Keeps abreast of current regulatory guidance and attends local, regional, or national conferences/seminars to remain current

  

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. 

Required Qualifications: 

  • Bachelor’s degree, 5+ years progressive, relevant knowledge toward mastery in the field accepted in lieu of Bachelor’s degree
  • Registered Nurse with current credentials or certified coder (CCS, CPC, COC, CCS-P)
  • Experience in Cerner clinical HER
  • Solid understanding of the charge methodologies and best practices within the enterprise electronic health record
  • Solid understanding of clinical documentation requirements to support charges generated
  • Solid understanding of technical aspects of charge generation within the enterprise EHR systems
  • Proficient with Microsoft business applications
  • Proven ability to work collaboratively with IT during the plan, build, test and go-live phases on an EHR implementation and/or upgrade
  • Proven ability to manage multiple projects and affective prioritization
  • Proven ability to complete time sensitive projects and work both independently and collaboratively
  • Proven excellent written and verbal communication skills
  • Proven customer oriented

Safety Requirements:

  • Assist in maintaining a work environment free from recognized hazards that create a risk or injury to employees, patients, or visitors
  • All accidents and incidents are reported by employees within 24 hours and supervisor to submit properly investigated report timely
  • Ergonomic evaluations are completed as needed
  • When appropriate, assist and support with the return of all workers with work related injuries and illness to gainful employment

 

Physical Demands:

  • Sedentary:  Exerting up to 10 lbs. occasionally, sitting most of the time, and only brief periods of standing and walking
  • Requires the ability to travel to member organizations as needed

  

California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The salary range for California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island or Washington residents is $67,800 to $133,100 per year. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

 *All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy