Remote Senior Nurse Auditor, RN

Ensemble

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Full time
Posted Today
R017252

Thank you for considering a career at Ensemble Health Partners!

 

Ensemble Health Partners is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country.

 

Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference

 

 

 

 

The Opportunity:

 

 

The Senior Nurse Auditor performs charge audits and client assessments as assigned by management. This role is responsible for timely resolution of all incorrect and/or missing charges prebill and post bill to prevent revenue loss and to ensure compliance requirements are met. Is responsible for monitoring & resolving revenue loss reports, assigned work queues, and identifying opportunities for any additional documentation needs to support captured charges. Fulfill audits requests by reviewing clinical documentation, identifying trends for missing and/or incorrect charges. Applies clinical knowledge to educate stakeholders on standards for documentation and charge capture practices and to look for opportunities of improvement based on audit outcomes. Serve as subject matter expert and is responsible for coaching, mentoring, & training of new hires and existing staff. Monitor the productivity and quality of the Nurse Auditors staff and report results to management on regular basis. Analyze trends and look for opportunities for process improvements to enhance team productivity and quality. Completes ongoing and adhoc charge audit requests within set deadlines. Responsible for maintaining audit logs and strive for customer service excellence while meeting the mission and goals of the organization, as well as meeting all regulatory compliance requirements.

 

Responsibilities:

 

  • Performs clinically driven revenue integrity audits and other assessments as assigned by management.
  • This role is responsible for timely resolution of all incorrect and/or missing charges to prevent revenue loss and to ensure compliance requirements are met.
  • Identifies opportunities for any additional documentation needs to support captured charges.
  • Fulfill audits requests by reviewing clinical documentation, identifying trends for missing and/or incorrect charges.
  • Applies clinical knowledge to educate stakeholders on standards for documentation and charge capture practices and to look for opportunities of improvement based on audit outcomes.
  • Responsible for reviewing Injection & Infusion work queues in Epic Hospital Billing system.
  • Resolve prebill and post bill missing and error charges identified by Opera Solutions software to ensure accurate and timely billing of services provided. Travel to client sites to conduct assessments and to provide education and training related to findings. Will be assigned to multiple clients and is responsible to support the client and the organization in meeting their financial goals.
  • Serve as subject matter expert for the Nurse Auditors staff to answer their questions and provide guidance on complex topics. Is responsible for coaching, mentoring, & training of new hires and existing staff. Help with creating and maintaining tip sheets and SOPs to assist with training of new hires. Monitor the productivity and quality of the Nurse Auditors staff to ensure they meet the department standards and report results to management on regular basis. Analyze trends and look for opportunities for process improvements to enhance team productivity and quality.
  • Plan and coordinates ongoing and adhoc charge audit requests. Responsible for maintaining audit logs and all required documentation. Review CMS, OIG, and other pertinent government websites to keep abreast of all the changes, how they may impact revenue, and update the annual audit plan accordingly. Maintain thorough understanding of government rules and regulations, generally accepted auditing standards and common audit procedures and techniques.
  • Works on ad hoc projects and assessments, & performs other duties as assigned

 

Requirements:

  • RN Licensure required
  • Three to five years of experience in healthcare industry applying clinical knowledge in completing comprehensive charge audits, reviewing and resolving revenue leakage reports, and managing Revenue Integrity projects as assign
  • Working knowledge of CPT/HCPCS/Revenue codes, charge capture and billing best practices, and government and non-government reimbursement guidelines. Excellent project management, analytical, interpersonal, oral & written communication skills. Strong leadership, mentoring, and training skills. Strong organization skills. Highly motivated and self starter with ability to complete assignments within time constraints and deadlines. Ability to thrive in a dynamic & fast paced work environment.
  • Experience in physician and hospital operations, compliance and provider relations.

#LI-LS1

#LI-REMOTE

 

Join an award-winning company

 

Three-time winner of “Best in KLAS” 2020-2022

2022 Top Workplaces Healthcare Industry Award

2022 Top Workplaces USA Award

2022 Top Workplaces Culture Excellence Awards

  • Innovation
  • Work-Life Flexibility
  • Leadership
  • Purpose + Values

 

Bottom line, we believe in empowering people and giving them the tools and resources needed to thrive. A few of those include:

  • Associate Benefits We offer a comprehensive benefits package designed to support the physical, emotional, and financial health of you and your family, including healthcare, time off, retirement, and well-being programs.
  • Our Culture – Ensemble is a place where associates can do their best work and be their best selves. We put people first, last and always. Our culture is rooted in collaboration, growth, and innovation.
  • Growth – We invest in your professional development. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement.
  • Recognition – We offer quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company.

 

Ensemble Health Partners is an equal employment opportunity employer. It is our policy not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender, gender identity, religion, national origin, age, disability, military or veteran status, genetic information or any other basis protected by applicable federal, state, or local laws.  Ensemble Health Partners also prohibits harassment of applicants or employees based on any of these protected categories.

 

Ensemble Health Partners provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law. If you require accommodation in the application process, please contact TA@ensemblehp.com.