Nurse Auditor - Revenue Integrity (Remote in Wisconsin)

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Job Title:

Nurse Auditor - Revenue Integrity (Remote in Wisconsin)

Cost Center:

101651059 Coding-Audit Appeals Educ

Scheduled Weekly Hours:

40

Employee Type:

Regular

Work Shift:

Mon-Fri; 8:00 am - 5:00 pm (United States of America)

Job Description:

**Wisconsin residents only eligible to apply**

JOB SUMMARY

The Nurse Auditor - Revenue Integrity is responsible for reviewing medical records to facilitate proper professional and/or facility coding of assigned specialties performed within the Marshfield Clinic Health System (MCHS). This individual acts as a liaison in providing accurate and timely information/guidance to physicians, allied providers, managers, and staff in regard to various coding and/or Medicare/Medicaid policy issues. The Nurse Auditor - Revenue Integrity is responsible for the initial development of payor or Recovery Audit Contractors (RAC) appeals correspondence materials.

JOB QUALIFICATIONS

EDUCATION

For positions requiring education beyond a high school diploma or equivalent, educational qualifications must be from an institution whose accreditation is recognized by the Council for Higher Education and Accreditation.

Minimum Required: Nursing diploma or Associate’s degree in nursing.

Preferred/Optional: Bachelor’s degree in nursing.

EXPERIENCE 

Minimum Required: Three years’ experience in medical setting or medical business office. Demonstrated knowledge of surgical and medical procedures.  Strong written and verbal communication skills and demonstrated knowledge of Microsoft Office Suite.

Preferred/Optional: Demonstrated knowledge of CPT, ICD-9/ICD-10, and HCPCS coding. Demonstrated knowledge of Inter-qual criteria.

CERTIFICATIONS/LICENSES 

The following licensure(s), certification(s), registration(s), etc., are required for this position. Licenses with restrictions are subject to review to determine if restrictions are substantially related to the position.

Minimum Required:

• Registered Nurse license awarded by the State of Wisconsin.

• Coding certification awarded by American Academy of Professional Coders (AAPC), American Health Information Management Association (AHIMA), or other approved coding certification must be obtained within three years of hire.

Preferred/Optional: Current coding certification awarded by American Academy of Professional Coders (AAPC), American Health Information Management Association (AHIMA), or other approved coding certification at time of hire.

**Wisconsin residents only eligible to apply**

Marshfield Clinic Health System is committed to enriching the lives of others through accessible, affordable and compassionate healthcare.  Successful applicants will listen, serve and put the needs of patients and customers first.

Exclusion From Federal Programs: Employee may not at any time have been or be excluded from participation in any federally funded program, including Medicare and Medicaid.  This is a condition of employment.  Employee must immediately notify his/her manager or the Health System’s Compliance Officer if he/she is threatened with exclusion or becomes excluded from any federally funded program.

Marshfield Clinic Health System is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.