Appeals RN, Hospital Charge Audit
Change Healthcare
 Remote, OR

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Here at Change Healthcare, we're using our influence to drive positive changes across the industry, and we want motivated and passionate people like you to help us continue to bring new and innovative ideas to life.

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Appeals RN – Hospital Charge Audit

Our Hospital Charge Audit Team works on behalf of payers to audit percent of charge reimbursed claims at acute care facilities. These are not medical necessity or DRG audits

The primary focus of the Appeals RN is to produce appeal responses to providers where the provider has appealed an audit completed by our team. This will involve reviewing the appeal presented by the provider, potentially updating audit findings, and clearly communicating our position in an appeal response.

Location: Remote/Telecommuter position. This role may be remote/telecommute from any state or may be located in our Lombard IL office

Responsibilities:

  • Perform appeals effectively and timely to meet client contractual turnaround times
  • Effectively interact and communicate with team members regarding all steps of the appeals
  • Participate as needed in team meetings, client meetings and/or provider meetings wherein nursing, policy and appeals expertise is required
  • Utilize nursing knowledge in conjunction with payer policies and CMS guidelines to appropriately review and respond to provider appeals and/or give guidance to audit staff
  • Provide written and verbal clinical rationale for appeal response
  • Responsible for facilitating auditor and team member feedback
  • Communicate with audit staff and triage team as need to discuss audit outcomes and potential for audit in selected claims and facilities
  • Other duties as assigned

Minimum Requirements:

Two years of clinical experience in an acute care hospital

Education:

Graduate of an accredited College or University

Current R.N. license required

Critical Skills:

2+ year's experience in Hospital Charge Audit, and Provider defense audit

2+ year's experience working with Payer reimbursement policies and or CMS guidelines interpretation

Knowledge of acute hospital billing requirement including UB-04s, revenue codes, itemization of charges, CPT codes, HCPCS codes ICD 9/10 diagnosis and procedure codes

Must possess strong skills in Microsoft office programs (Word, Excel, Outlook specifically). This individual will spend most of the workday in these programs

Excellent organizational skills with a strong focus on attention to detail

Ability to follow up and resolve issues in a timely manner

Excellent critical thinking/problem solving skills

Excellent verbal and written communication skills

Ability to work independently as well as recognize when office support is needed

Ability to multi-task in a fast-paced environment

Ability to organize, plan, prioritize and complete assignments within the required time frame

Preferred Skills:

Medical coding designations including but not limited to: CCS, CPC, COC, RHIT

Physical requirements

General office requirements; The ability to sit at a desk, computer and use telephone for extended periods of time

If located near Lombard, IL office, no travel should be required

If located out of area, travel for orientation/training as well as up to twice per year for team meetings

Employees in roles that require travel will need to be able to qualify for a company credit card or be able to use their own personal credit card for travel expenses and submit for reimbursement

Join our team today where we are creating a better coordinated, increasingly collaborative, and more efficient healthcare system!

Equal Opportunity/Affirmative Action Statement

Change Healthcare is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status. dol.gov/ofccp/regs/compliance/posters/pdf/OFCCP_EEO_Supplement_Final_JRF_QA_508c.pdf.

If you need a reasonable accommodation to assist with your application for employment, please contact us by sending an email to applyaccommodations@changehealthcare.com with “Applicant requesting reasonable accommodation“ as the subject. Resumes or CVs submitted to this email box will not be accepted.

gov/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf to view our pay transparency nondiscrimination policy.

Change Healthcare maintains a drug free workplace and conducts pre-employment drug-testing, where applicable, in accordance with federal, state and local laws.