Revenue Integrity Charge Auditor

Job not on LinkedIn

🔥 43 minutes ago

⛷️ Utah – Remote

⛷️ Utah – Remote

💵 $41 - $62 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

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IMH

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2007

🏗️ Construction

📦 Logistics

🛡️ Insurance

Construction • Logistics • Insurance

IMH is the Groupe IMA entity providing end-to-end housing assistance and post-claim services across France. It operates 24/7 emergency call-taking and rapid-response interventions for home incidents (fires, water damage, electrical faults, locksmithing), offers remote damage expertise and cost estimation, and manages repair-in-kind through a national network of vetted contractors. IMH also runs digital platforms to support project estimation and paid home-service offerings, coordinates large-scale catastrophe responses, and connects insurers, beneficiaries and service providers via its accredited prestataire network.

📋 Description

• Consult on clinical charge audits for Intermountain Health • Execute clinical charge audits of medical records for denials review, defense audits, disallowed charges, and retrospective reviews • Serve as a clinical resource for Intermountain Health Revenue Cycle departments • Maintain knowledge of laws, rules, regulations, hospital charging and coding, clinical quality, and clinical policy guidelines • Ensure compliance and protection of information • Manage, maintain, and communicate denial activity to stakeholders through the denial process, including medical review boards and court proceedings • Use evidence-based utilization review criteria to determine viability for commercial and governmental insurance audits • Assess clinical appeal requests by analyzing payer policies and Federal/State regulations • Collaborate with multidisciplinary stakeholders during audits • Identify and communicate denial root causes to healthcare team members • Serve as subject matter expert for hospital charging, documentation requirements, clinical disease processes and treatment, and medical necessity decisions • Support clinical departments with audit research and regulatory analysis • Provide guidance on policy and procedure development, training, and clinical education to reduce clinical denials • Maintain understanding of assigned projects, technology, products, organizational activities, and systems • Complete ongoing education and CEU requirements to maintain licensure and certifications

🎯 Requirements

• Graduate of an accredited school of nursing • Bachelor of Science in Nursing (BSN) from an accredited institution; education is verified • Current licensure as a registered nurse required • Current coding certification through AAPC or AHIMA • Experience with Microsoft Office, electronic medical record systems, and electronic databases • In-depth knowledge of the healthcare claim denial process • Clear understanding of the healthcare revenue cycle • Ability to use nationally recognized evidence-based utilization review criteria such as Milliman Care Guidelines (MCG) or InterQual • Ability to assess clinical appeal requests using payer policies and Federal/State regulations • Video phone screens and interviews through Microsoft Teams required • Potential onsite interviews and meetings • Must not reside or plan to reside in California, Connecticut, Hawaii, Illinois, Massachusetts, Maine, Minnesota, New York, Pennsylvania, Rhode Island, Virginia, Vermont, or Washington • Preferred: Master of Science in Nursing (MSN), EPIC experience, clinical experience in hospital care settings or auditing experience, utilization review and/or case management experience, hospital insurance billing, third-party claim/charging audits, or healthcare auditing experience • Skills in collaboration, problem solving, critical thinking, detail orientation, clinical judgment, written and oral communication, patient/hospital advocacy, computer literacy, efficiency, and results focus

🏖️ Benefits

• Generous benefits package covering programs supporting wellness, health, security, connection, and engagement • Flexible work options where approved and stated • Remote work option • Company equipment subject to remote work expectations • Ongoing education and CEU requirements support for maintaining licensure and certifications

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