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Clinical Nurse Auditor – Rev Cycle
The University of Kansas Health SystemClinical Nurse Auditor handling clinical reviews and collaborating on authorization issues for healthcare services. Assisting in quality improvement and patient care processes within the revenue cycle.
About the role
Key responsibilities & impact- Working with pre-certification / authorization / denials teams to assist in obtaining up front authorization for services rendered.
- Assisting with denial management and resolution.
- Collaborating with HIM, PFS, Case Management and multiple clinical departments to resolve account problems related to authorization of services and account resolution.
- Reviewing protocols to assist in ensuring services being billed as standard of care are evidenced based and meeting industry guidelines.
- Evaluating and resolving issues related to the revenue cycle including medical documentation, utilization review and medical necessity.
- Providing training to improve revenue cycle processes.
- Recommending policies and procedures improvements to increase efficiencies
- Supporting process improvement activities to assure medical record compliance
Requirements
What you’ll need- Bachelor Degree in Nursing
- 2 or more years experience in utilization review, clinical review, or authorizations
- Licensed Registered Nurse (LRN) - Multi-State - State Board of Nursing
- Current State RN license
- EPIC experience
Benefits
Comp & perks- The health system is an equal employment opportunity employer.
- Provides reasonable accommodations to qualified individuals with disabilities.
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
utilization reviewclinical reviewauthorizationdenial managementmedical documentationmedical necessityrevenue cycle managementevidence-based protocolsprocess improvementtraining
Soft Skills
collaborationproblem-solvingcommunicationorganizational skillspolicy recommendation
Certifications
Bachelor Degree in NursingLicensed Registered Nurse (LRN)Current State RN license