This position partners with various departmental staff and physicians to review patient accounts for appropriate status, medical necessity, and compliance with National and Local Coverage Determinations (NCD) (LCD), while serving as a resource and educator to departmental staff and physicians regarding appropriate patient status, charge capture, billing, medical necessity, Medicare guidelines, and payment methodologies with the primary goal of improving the performance of Revenue Cycle processes including developing best practices, clinical documentation, coordinating issue resolution, and establishing proactive prevention measures.

• Require Bachelor’s degree in Nursing. Relevant RN experience may substitute on a year for year basis for the required degree

• Prefer previous auditing experience.
• Prefer Coding certification from the American Health Information Management Association or American Academy of Professional Coders within one (1) year of hire date.
• Prefer demonstrated knowledge of Medicare, Medicaid, and Commercial payment methodologies and benefit coverage.
• Prefer demonstrated knowledge of medical necessity rules including NCDs and LCDs.
• Prefer demonstrated knowledge of the Medicare inpatient only list.
• Prefer demonstrated proficiency in verbal and written communication.
• Prefer demonstrated ability to relate well to others in a variety of functional areas, handle multiple responsibilities simultaneously and to problem-solve and think both creatively and analytically.
• Prefer demonstrated customer service skills and the ability to work effectively with hospital staff, physicians, and physician office staff.
• Prefer a minimum of three (3) years of experience in revenue cycle practices.

FL RN: FL Registered Nurse License