Registered Nurse - Payment Auditor - Sacramento

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Registered Nurse - Payment Auditor
Sacramento, California
The city of Sacramento is the capital of California, with a population of over 500,000. The broader Sacramento metro area is home to over 2.4 million residents. Sacramento is a major center for healthcare, with world-renowned UC Davis School of Medicine close by, making it an ideal location for talented healthcare professionals. Whether you prefer to work in a hospital, clinic, home care or senior housing setting - Sacramento job opportunities in healthcare are abundant.
Our client is a local and integrated healthcare provider that prides themselves in investing in the communities that we serve. They continue to provide innovative care models focused on improving quality and access to healthcare and are seeking a Registered Nurse who is passionate and lines up with their mission and values. If you are excited about the growing fields of Analytics and who would like to join an amazing team!
Registered Nurse - Payment Auditor Responsibilities:
  • Conducts reviews and responding to insurance denials
  • Writes concise, factual letters and provides medical record documentation to support appeal
  • Effectively communicates verbally with external and internal customers to ensure argument for appeal is clearly presented
  • Prioritizes and organizes own work to meet appeals and grievance deadlines
  • Responsible for the denials process, including subsequent appeal to health insurance
  • Reviews for completeness of documentation based on charges
  • Reviews charges for completeness and accuracy based on documentation
  • Determines if charges supported by documentation have been missed
  • Demonstrates awareness of departmental charging procedures and serves as a liaison between department managers and Patient Financial Services.
  • Demonstrates awareness of payer specific reimbursement methodologies and payer specific policies and procedures regarding charging, coding, billing, claim processing, and dispute resolution to assist patients and employees.
  • Assists and educates patient representatives regarding pricing questions and item descriptions as needed to increase efficiency
  • Performs patient inquiry audits as requested
  • Provides audit results and written explanation of line items (if needed) to the patient representative or supervisor
Registered Nurse - Payment Auditor Qualifications:
  • Associate's Degree Graduate from an accredited NLN/CCNE institution required
  • 2 years RN experience required
  • Nursing\RN - Registered Nurse - State Licensure and/or Compact State Licensure required