What are the responsibilities and job description for the RECOVERY AUDIT NURSE position at Nash UNC Health Care?
The Recovery Audit Nurse will work closely with Business Office staff members to assist in facilitating in the following:
- Clinically related reviews of patient accounts/claims to ensure compliant billing guidelines (internal and external) are followed (including, but not limited to Discharge Disposition, Medicare 3-Day Rule, and Outpatient Facility-based Infusion and Hydration charging)
- Reviews and follow up of claims denied by insurance companies with primary focus on managed-care and commercial payers (will work closely with Case Management / Utilization Review staff)
- Reviews and appeals for hospital patient accounts/claims denied payment through retrospective or prospective review, i.e. - Medicare and Medicaid RA (Recovery Auditor) programs.
Education, Licensure, Experience, and Other Requirements:
- Graduate of an approved nursing program with a current license to practice as a Registered Nurse in North Carolina
- Minimum of 2 years acute care RN experience
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Minimum of 1 year Case Management, UR, Hospital Billing, Compliance, or Charge Capture experience
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