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RN NURSE AUDITOR I

St. Francis Hospital
Greenville

Job Description

Responsible for coordinating the process to appeal clinical denials, managing the process of completing collection and accounts receivable activities for clinical denials, and for ensuring all hospital collection-related activities meet department requirements.

Qualifications

The following qualifications are the minimum necessary to adequately perform this job. However, any equivalent combination of experience, education and training which provides the necessary knowledge, skills and abilities would be acceptable, subject to any legal and/or regulatory requirements.

1. Graduate of an accredited Registered Nursing Degree Program (ADN, Diploma, or BSN). Baccalaureate degree
preferred or commensurate experience in lieu of bachelors degree. Must have an active, unrestricted RN
license.
2. At least 2 years of direct experience in Denials and/or Collections Management, Utilization Management or
Case Management preferred.
3. Nurse Auditor education/experience and RN license required; other clinical documentation experience a plus.
4. Must have clinical knowledge and be able to interpret hospital medical documentation.
5. Must have demonstrated knowledge of collections management.
6. Must be able to manage claim denial activities.
7. Must have a good understanding of reimbursement methodologies and terms.
8. Must understand payer billing requirements.
9. Must be able to demonstrate a working knowledge of personal computers and other standard office equipment.

Employment Type

FT

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