Clinical Nurse Auditor – Rev Cycle

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The University of Kansas Health System

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1998

⚕️ Healthcare Insurance

📚 Education

🤝 Non-profit

Healthcare Insurance • Education • Non-profit

The University of Kansas Health System is a comprehensive healthcare provider that partners with the University of Kansas Medical Center to offer top-tier medical services and education. It is recognized for its excellence in patient care, research, and education, with services ranging from urgent care to specialized cancer treatment at its NCI-designated cancer center. As a nonprofit organization, it relies on donations to provide high-quality healthcare to the community. Additionally, it offers a variety of educational opportunities through residency programs and fellowships, and emphasizes the importance of wellness and holistic health management for patients and professionals alike.

📋 Description

• 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

• 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

• The health system is an equal employment opportunity employer. • Provides reasonable accommodations to qualified individuals with disabilities.