Rn- Denials/Charge Audits, Full Time, First Shift

UC Health is hiring a Full Time RN (Denials/Charge Audits) for Patient Financial Services

Under the supervision of the Manager of Denials-Charge Audits, the Denials Management (DM) nurse will use established criteria and policies/procedures to perform reviews on denied accounts.  Utilizing knowledge of utilization management regulations, registration, claims, and payor policies the Denial Management nurse will work assigned accounts to maximize reimbursement for the organization.   

About Uc Health

UC Health is an integrated academic health system serving Greater Cincinnati and Northern Kentucky. In partnership with the University of Cincinnati, UC Health combines clinical expertise and compassion with research and teaching—a combination that provides patients with options for even the most complex situations. Members of UC Health include: UC Medical Center, West Chester Hospital, University of Cincinnati Physicians and UC Health Ambulatory Services (with more than 900 board-certified clinicians and surgeons), Lindner Center of HOPE and several specialized institutes including: UC Gardner Neuroscience Institute and the University of Cincinnati Cancer Center. Many UC Health locations have received national recognition for outstanding quality and patient satisfaction. Learn more at uchealth.com. 

Patient Population - (Clinical Only):

•  Engages in population appropriate communication.
• Has knowledge of growth and development milestones and tasks.
• Gives clear instructions to patients/family regarding treatment.
• Involves family/guardian in the assessment, initial treatment and continuing care of the patient.
• Identifies any physical limitations of the patient and deploys intervention when necessary.
• Recognizes and responds appropriately to patients/families with behavioral health problems.
• Interprets population related data and plans care appropriately.
• Identifies and responds appropriately to different needs resulting from, unique psychological needs or those associated with religious / cultural norms. Performs treatments, administers medication or operates equipment safely.
• Recognizes and responds to signs/symptoms of abuse or neglect.
• Performs reviews of patient records for completion of TJC core measure cases.  Enters data into Midas system. Prepares reports and other documentation to improve the processes of care.  Works with hospital PI committees responsible for improving these processes.
• Performs reviews of patient records to monitor for quality outcomes using population-specific clinical database based on established indicators.  Enters all utilization and quality data into the database system as outlined in procedures.  Responsible for transmission of data to appropriate registry on a routine basis.
• Identify actual and potential delays in service or treatment and opportunities for improvement (OFI) and refer to the appropriate individuals within the multidisciplinary patient care teams. Receives comparative reports from registry and handles all necessary correspondence and communication with the registry.
• Identifies appropriate data to be collected and assists in formulation of strategies for performance improvements including complications, adverse outcomes, etc.  Participates in process improvement teams as developed for this project.
• Serves as a consistent resource regarding project specific quality information and trends.  Participates in project related organization wide activities in order to coordinate data analysis efforts.  Maintains knowledge of current trends and developments in the field.
• Minimum Required:
• Preferred: Bachelor's Degree - RN   
• Minimum Required: 1 - 2 Years equivalent experience
• Preferred: 3 - 5 Years equivalent experience
• Ability to effectively communicate with and effectively gain cooperation of attending physicians in regards to documentation needs and to effectively influence all members of the interdisciplinary care team to achieve appropriate resolutions.  Effective written and verbal communications.  Ability to interpret medical data as documented.
• Quality management, utilization management or case management preferred.
• Current knowledge of rules, regulations, policies and procedures related to third party payors, TJC, CMS and other regulatory agencies.
• Knowledge of evidence-based practice and principles, care plan development and core measures.
• Knowledge and training in computer systems to perform position responsibilities such as EPIC, Midas, Microsoft Office products 
• While the position is primarily a remote working environment, travel to the various hospitals and work locations may be necessary based on business needs. Work hours will vary from time to time depending upon the needs of the business. 
• Associate's Degree - RN
• Other: Diploma Nurse 

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At UC Health, we're proud to have the best and brightest teams and clinicians collaborating toward our common purpose: to advance healing and reduce suffering.

As the region's adult academic health system, we strive for innovation and provide world-class care for not only our community, but patients from all over the world. Join our team and you'll be able to develop your skills, grow your career, build relationships with your peers and patients, and help us be a source of hope for our friends and neighbors. UC Health is an EEO employer.