Henry Ford Health Corp - Warren, MI
posted 2 months ago
Full-time - Mid Level
Warren, MI
1,001-5,000 employees
Ambulatory Health Care Services
About the position
The RN-Charge Auditor position at Henry Ford Health involves coordinating payer denials and appeals, responding to insurance requests for medical records, and conducting medical record reviews to ensure billing accuracy. The role is primarily remote, with a focus on auditing and compliance with insurance guidelines, requiring a strong background in nursing and medical billing processes.
Responsibilities
- Coordinate payer denials and appeals, responding to insurance company requests for medical records.
- Perform medical record reviews to determine accuracy of billing through verification of coding, billing, and supporting clinical documentation.
- Coordinate all activities associated with insurance carrier audit requests and work with payers to ensure timely handling of these audits.
- Review technical payer denials and determine whether an appeal is justified.
- Write and track technical appeal letters and relay information with the billing department.
- Conduct audits to ensure accurate charge capture, enhance reimbursement, and identify savings potential.
Requirements
- Diploma from an accredited school/college of nursing or required professional licensure at time of hire.
- Bachelor's degree in Nursing (BSN) preferred.
- 3-5 years experience in hospital nursing, especially in areas such as OR, L&D, Neuro-Surg, IR, ICU, ER, Ortho, Endo, Cardiac Cath.
- Experience in medical record review, billing and coding accuracy, and insurance carrier audit requests.
- Knowledge of billing and charging rules as it relates to clinical services.
Nice-to-haves
- Credentials in financial auditing or coding.
- Experience in Utilization Review (UR).
- Familiarity with CPT and ICD-10 codes and Medicare guidelines.
Benefits
- Dental insurance
- Health insurance
- Tuition reimbursement
