Medical Audit & Appeal Nurse - Atrium Health

Job Req ID: 828361

Position Number: 00119447

Employment Type: Full Time

Shift: Day

Shift Details: M - F, 8a - 5p

Standard Hours: 40.00

Department Name: PFS - Audit and Appeals

Location: Corporate Operations

Location Details: 

Our mission is to improve health, elevate hope and advance healing - for all. The name Atrium Health allows us to grow beyond our current walls and geographical borders to impact as many lives as possible and deliver solutions that help communities thrive. For more information, please visit atriumhealth.org/about-us.

 

 

Job Summary

Registered Nurse who is responsible for performing Audits and Clinical Appeals as related to medical necessity, appropriateness of patient status and providing education and guidance to practitioners and other team members.



Essential Functions

 

 

• Identifies accounts and actions to secure compliance for Medicare and Medicaid.


• Prepares and processes appeals on denied accounts in a timely manner. This includes an assessment of the account, strategy plan and written communication designated by governmental agents as outlined for the appeal process.


• Performs audits as outlined by governmental guidelines for charges and billing accuracy.


• Functions as a liaison with governmental agencies to facilitate the audit process as needed through written and verbal communication.


• Functions as a resource for education for Charlotte Metro facilities and regional facilities as outlined.


• Interfaces and collaborates with Clinical Care Management and Coding to ensure appropriate level of care has been met and billing is compliant with both.


• Develops and presents educational materials related to issues identified.


• Communicates with internal and external customers in relation to regulatory guidance.


• Maintains current knowledge of Interqual, Medicare and Medicaid guidelines.

Physical Requirements

Environment requires the ability to concentrate, analyze information and sit for long periods of time. Frequent interruptions require flexibility in performance of duties. Ability to communicate well and comfort in speaking among groups. Each teammate is responsible for working in a safe manner. Requires some travel and use of personal vehicle.



Education, Experience and Certifications

Graduate of an accredited program of Nursing required. Current NC RN license required. 1 - 3 years of hospital nursing experience in various clinical areas. BSN preferred. Basic Life Support for Healthcare Provider (BLS HCP) from AHA required. Demonstrates analytical ability, initiative and resourcefulness. Microsoft Office experience preferred. Excellent planning and organizational skills. Excellent verbal and written communication skills. Previous experience submitting government audit appeals preferred.

 

 

 

 

At Atrium Health, our patients, communities and teammates are at the center of everything we do. Our commitment to diversity and inclusion allows us to deliver care that is superior in quality and compassion across our network of more than 900 care locations.

 

As a leading, innovative health system, we promote an environment where differences are valued and integrated into our workforce. Our culture of inclusion and cultural competence allows us to achieve our goals and deliver the best possible experience to patients and the communities we serve.

 

Posting Notes: Not Applicable

Atrium Health is an EOE/AA Employer