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Job Summary

Supports the pre-billing review of claims for all payors to ensure that appropriate, compliant and timely billing occurs for assigned branch locations. Conducts both clinical and/or technical audits as prescribed by branch policy & procedure and as directed by leadership. Maintains current knowledge on billing compliance requirements for payors. Provides organizational and branch leadership with timely reports, updates and recommendations for educational opportunities as it relates to audit outcomes. Acts as the liaison with the Branch Leadership and Billing Dept. and participates in regularly established communication/meetings with the branch to ensure timely month-end close.

Essential Functions

• Performs pre-bill auditing workflow per service line to ensure all branch issues are worked timely and accurately.

• Runs assigned pre-bill reports and monitors indicators for trends and barriers to meeting agency billing metrics.

• Stays current in EMR system and identifies system issues, processes and/or opportunities for enhancements to ensure accurate and efficient billing.

• Stays current with all general payor requirements for compliant billing practices as well as state and federal regulations.

• Compiles and provides reports from clinical audit outcomes monthly for quarterly review with Operations.

• Participates in Billing/Operations and/or Compliance meetings as requested.

• Provides activities/action items to improve team member engagements, supports cultural diversity and an open work environment of positive interdepartmental communication.

Physical Requirements

Works in an office environment. Requires long periods of sitting and computer work. May periodically drives to and from branches and/or regional meetings in varied weather and traffic conditions.

Education, Experience and Certifications

Graduate of an accredited school of nursing required. BSN required. RN candidates for external hire or internal promotion without BSN must be enrolled in a BSN program within one year of Hire/Transfer date and must complete program within 3 years of enrollment in the program. 1-year service line nursing experience required. 2-3 years auditing/healthcare reimbursement experience preferred. Strong computer skills, proficient in Microsoft applications, ability to problem solve, analyze and communicate effectively, critical thinking skills. Work related to healthcare compliance preferred. Coding experience preferred. Current RN license or temporary license as a Registered Nurse Petitioner in the state in which you work and reside or; if declaring a National License Compact (NLC) state as your primary state of residency, meet the licensure requirements in your home state; or for Non-National License Compact states, current RN license or temporary license as a Registered Nurse Petitioner required in the state where the RN works. Additional education, training, certifications, or experience may be required within the department by the nurse leader.