Audit and Billing Compliance Specialist – UAMS Health Benton/Bryant

• Bachelor’s degree plus 3 years’ experience in nursing, or coding/auditing functions OR
• High School diploma plus 7 years’ experience in nursing, or professional coding/auditing functions.
• Must have current RN, or CCS, CCS-P or CPC certification and an understanding of the revenue cycle. Requires a demonstrated ability to present information verbally; strong written communication skills with attention to detail; have demonstrated ability to work with physicians and must be able to work in and manipulate data successfully in EXCEL. Prefer CPMA or CEMC certification.

• BSN, ADN, CPC, CCS
• One year of case management, coding, charge capture, auditing, or hospital billing
• Hospital coding knowledge

• Sedentary Work | Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly. Sedentary work involves sitting most of the time.
• The employee is required to have close visual acuity to perform an activity such as: preparing and analyzing data and figures; transcribing; viewing a computer terminal; extensive reading; and/or visual inspection at distances close to the eyes.
• The employee is not substantially exposed to adverse environmental conditions (such as in typical office or administrative work).
• Constant physical activities: Manipulate items with fingers, including keyboarding; Repetitive Motion; Sitting
• Frequent physical activities: Hearing; Talking
• Occasional physical activities: Crouching; Kneeling; Reaching; Standing; Stooping; Walking

This position is subject to pre-employment screening (criminal background, drug testing, and/or education verification). A criminal conviction or arrest pending adjudication alone shall not disqualify an applicant except as provided by law. Any criminal history will be evaluated in relationship to job responsibilities and business necessity.  The information obtained in these reports will be used in a confidential, non-discriminatory manner consistent with state and federal law. 

• →Supports and/or completes clinical denials, particularly in the outpatient arena and particularly where the authority of a nurse will be beneficial to the success of the appeal.
• →Investigates the reason for the denial, make a determination for the appeal, and provide denials team member’s documentation to support an appeal.
• →Collaborates with staff to complete and resolve billing requirements, which require clinical expertise, including certain Blue Cross bar code letters, Medicaid pharmacy authorizations, and other third-party inquiries, which delay claims adjudication.
• →Provides high level oversight for staff by offering clinical expertise. Work in collaborative effort with leadership, department directors and physicians to enhance and maintain revenue cycle processes to ensure the capture of information required for billing and procuring payment from third parties and patients; responsible for actively monitoring operational and financial performance to identify opportunities for improvement and anticipate and meet the needs of leadership; identifies and drives change in processes that will improve efficiencies and improve core throughput in all revenue cycle related functions. 
• →Responsible for oversight of the quality hospital billing guidelines and charges posted by operations providing daily and immediate clinical expertise to charge capture activities.
• →Supports and resolves edits discovered by the Revenue Guardian within EPIC. Answers questions from colleagues regarding missing charges or the appropriateness of charges.
• →Completes daily work list of bills holding for charge capture issues. Must meet departmental productivity standards on a regular basis. Responsible for working all assigned Revenue Guardian work queues in EPIC.
• →Evaluates research and determine appropriate charging for accounts assigned to the Nurse Audit Queue within five business days. Work accounts in a thorough and accurate manner and take appropriate action.
• →Works with clinical departments to address missing or complex documentation in a professional manner. Identify charging patterns and notify department and/or management so issues can be resolved. Responsible for working assigned claim edit work queues daily, ensuring that a sufficient number of medical records are addressed for quality in conjunction with compliance.
• →Performs charge audits. Assess, analyze, and arbitrate external audits within the guidelines of the external charge audit policy. 
• →Performs other duties as assigned.

Please contact askrecruitment@uams.edu for any recruiting related questions.

All application materials must be uploaded to the University of Arkansas System Career Site https://uasys.wd5.myworkdayjobs.com/UASYS  

Please do not send to listed recruitment contact.