Audit RN – Revenue Integrity

WHY UT SOUTHWESTERN?
With over 75 years of excellence in Dallas-Fort Worth, Texas, UT Southwestern is committed to excellence, innovation, teamwork, and compassion. As a world-renowned medical and research center, we strive to provide the best possible care, resources, and benefits for our valued employees. Ranked as the number 1 hospital in Dallas-Fort Worth according to U.S. News & World Report, we invest in you with opportunities for career growth and development to align with your future goals. Our highly competitive benefits package offers healthcare, PTO and paid holidays, on-site childcare, wage, merit increases and so much more. We invite you to be a part of the UT Southwestern team where you’ll discover a culture of teamwork, professionalism, and a rewarding career!

BENEFITS
UT Southwestern is proud to offer a competitive and comprehensive benefits package to eligible employees. Our benefits are designed to support your overall wellbeing, and include:

• PPO medical plan, available day one at no cost for full-time employee-only coverage
• 100% coverage for preventive healthcare-no copay
• Paid Time Off, available day one
• Retirement Programs through the Teacher Retirement System of Texas (TRS)
• Paid Parental Leave Benefit
• Wellness programs
• Tuition Reimbursement
• Public Service Loan Forgiveness (PSLF) Qualified Employer
• Learn more about these and other UTSW employee benefits!

EXPERIENCE AND EDUCATION
Required

• Education
  Graduate of an accredited nursing program.

• Experience
  5 years of clinical experience as a RN and
  2 years performing utilization review, charge audit, case management or denial/appeal functions in an acute care hospital. and
  Principles of Managed Care, Medicare/Medicaid reimbursement required

• Licenses and Certifications
  (RN) REGISTERED NURSE

JOB DUTIES

• Prepare for and conduct audits requested by governmental and managed care payors, comparing clinical documentation to charges billed to identify any possible under/over charges; documents and sends audit results to payor organizations or external auditors for review and resolution as applicable; maintains communication with auditors and other relevant individual/organizations until all discrepancies are resolved.
• Performs internally defined audits to identify under/over charges; reviews charges posted to the claims against the necessary clinical documentation to identify any possible under/over charges; documents audit findings and sends results to appropriate departments.
• Performs charge audits as requested by patients; reviews billed charges for patients who are disputing charges by comparing the charges against all necessary clinical documentation and looking for discrepancies; documents audit results; posts corrections to accounts; communicates back to appropriate departments and sends to PFS/Customer Service for rebilling if necessary.
• Conducts review of accounts that have not been paid according to their contractual agreement because of denied charges; compares charges with clinical documentation to determine the validity of the denial and/or identifies any charge discrepancies; documents audit findings; posts adjustments to accounts and sends to appropriate department for rebilling and/or payment correction if necessary.
• Assists departments with the charge reconciliation process. Works with all relevant hospital departments to provide timely education on how to correct or improve processes that have been found to be deficient.
• Works with various staff and departments such as Health Information Management, clinical nursing units, physicians and others to obtain the information necessary to perform account audits.
• Complete special projects as identified and needed.

SECURITY AND EEO STATEMENT
Security
This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information.

EEO Statement
UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. As an equal opportunity employer, UT Southwestern prohibits unlawful discrimination, including discrimination on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, gender expression, age, disability, genetic information, citizenship status, or veteran status.