You bring your body, mind, heart and spirit to your work as a Clinical Billing Auditor Registered Nurse.
Youâ™re generous with your thoughts, your partnerships and especially your voice, because your opinion matters.
Youâ™re great at what you do, but you want to be part of something even greater. Because you believe that while individuals can be strong, the right team is invincible.
System Services is our Corporate Headquarters in Broomfield, Colorado and is located within the Oracle campus. SCL Health is a faith-based, nonprofit healthcare organization dedicated to improving the well-being of the people we serve.
Benefits are one of the ways we encourage health for you and your family. Our generous package includes medical, dental and vision coverage. But health is more than a well-working body: it encompasses body, mind and social well-being. To that end, weâ™ve launched a Healthy Living program to address your holistic health. Healthy Living includes financial incentives, digital tools, tobacco cessation, classes, counseling and paid time off. We also offer financial wellness tools and retirement planning.
Together weâ™ll align mission and careers, values and workplace. Weâ™ll encourage joy and take pride in our integrity.
Weâ™ll laugh at each otherâ™s jokes (even the bad ones). Weâ™ll hello and high five. Weâ™ll celebrate milestones and acknowledge the value of spirituality in healing.
Weâ™re proud of what we know, which includes how much there is to learn.
As a Clinical Billing Auditor RN you need to know how to:
Conduct objective reviews of patient accounts when requested by payers, audit firms, associates, or patients. Correct charges or other information as needed to ensure accurate claims. Develop appeals related to clinical or medical necessity denials. May act as the primary contact for follow up and oversight of any remediation required by audit findings.
Utilize department work queues to perform claim reviews, appeal assessments, charge corrections, and or other account activities which require clinical review or expertise. Utilize evidence based practice guidelines and federal, state, local billing regulations and/or payer guidelines including LCDs/NCDs in support of the appeal response or other billing decisions.
Act as a liaison to payers, business partners, and associates in coordinating and assisting with denial and appeal activities. Attend or conduct regular meetings with care sites to review appeal opportunities and findings.
Determine appeal response in collaboration with audit analysts, care site audit response teams, care management, appeal assistance business partner, corporate compliance, legal counsel, health information management, SCL Health associates, and any others involved in the audit response process. Communicate appeal activity and outcomes for each care site and the system when requested. Collaborate with Clinical Documentation Improvement (CDI), Decision Support, Compliance Revenue Integrity and/or Care Management to provide education based on outcomes of audits and appeals.
Develop and provide education to clinical teams regarding documentation requirements as needed. Monitor, analyze, communicate, and implement new or updated requirements related to government or other payer audits.
We hire people, not resumes. But we also expect excellence, which is why we require:
Current RN license in state of practice, required
Minimum of three (3) years of work experience in hospital insurance billing, utilization review or care management, third party claim audits, or compliance and auditing in a healthcare setting, required
Highly prefer prior experience with appealing Medicare and Medicaid
Experience with regulatory audits, preferred
Qualified candidate may work 100% remote
Your next move.
Now that you know more being a Clinical Billing Auditor RN on our team we hope youâ™ll join us. At SCL Health youâ™ll reaffirm every day how much you love this work, and why you were called to it in the first place.
*Selected candidate must be able to travel & train in Broomfield, CO.
Internal Number: 20003797
About SCL Health
SCL Health is a faith-based, nonprofit healthcare organization that operates eight hospitals, four safety net clinics, one children’s mental health center and more than 190 ambulatory service centers in three states – Colorado, Kansas and Montana. The health system includes 15,000 full-time associates and more than 500 employed providers.