Lead Revenue Integrity Nurse

Summary

Job Description:

Baptist Health is looking for a Lead Revenue Integrity Nurse to join our team! This is a remote work position that requires residency in KY or IN

Supports the clinical staff performing Denial or Audit Management and Payor Compliance at all facilitiesand corporate offices. Supports hospital service line managers and any employees in the facilities whoreport to other areas and perform appeal activity as part of their duties. Also performs payor compliance
review on accounts to determine medical necessity of services, pre and post service as well as pre andpost billing. Obtains predeterminations / prior authorizations when required by payor. Reviews and worksmedical necessity denials from commercial and governmental payors, including audits performed by RACs
or similar Medicare and Medicaid programs. Responds to all denials or payor audits with best possible efforts to recover outstanding revenue or prevent future revenue loss, meeting all appropriate payor orgovernment timelines. Serves as clinical resource for other revenue cycle staff.

Qualifications:

• BSN required.

• Two years' experience in revenue cycle related positionincluding at least one year supervisory, team lead, orcharge nurse experience

• Valid Kentucky Licensure as a Registered Nurse

Work Experience

Education