Nurse Manager, Revenue Integrity

Summary

Job Description:

Baptist Health is looking for a Nurse Manager, Revenue Integrity to join our team! This is a remote position that requires residency in KY or IN

Supports day-to-day operations for Authorizations and Denials Management, providing direct support to team members when needed. This role is responsible for integrating clinical expertise with payer policy, regulatory requirements, and revenue cycle operations to prevent patient access delays due to pending authorizations, reduce preventable denials, optimize reimbursement, and ensure compliant billing practices. Collaborates with the Director to lead the development, implementation and maintenance of standardized policies, procedures and strategies including authorization workflows, collaborating with Physicians, Mid-level providers and office staff for both denials prevention and authorizations, managing work queues, reviewing payer policies, and providing clinical support. Serves as a system expert in Authorizations and Denials Management.

Essential Duties:

• Solves problems and serves as a resource throughout the system on authorizations and denials management subject matter to promote compliance between documentation and payor coverage guidelines.

• Constantly collaborates with staff to seek more efficient methods for completing tasks.

• Identifies process improvement opportunities and develops plans to implement process improvement in collaboration with Managers, Director, or AVP. Communicates process improvement plans with staff and facilitates implementation.

• Listens to the needs and concerns of corporate and local leadership regarding specific needs in their markets and supports the leadership team in developing an appropriate plan to respond considering the overall organization and all its departments.

• Collaborates with other departments and physician offices as necessary to prevent revenue loss, both in a reactive response to authorizations / denials / underpayments / payer audits as well as in a proactive response to changes in payor / governmental authorization and coverage guidelines.

• Informs hospital departments (Scheduling, Registration, Case Management, etc.) of denials that resulted from process breakdowns in collaboration with Director and AVP in an effort to prevent future denials.

• Assists Director with improvement upon current provider documentation practices to be used for coding and payer coverage guidelines.

Qualifications:

• BSN with minimum 3 years of revenue cycle experience is required.

• In lieu of a bachelor's degree, associate's degree with five years management/supervisory/team leader experience in revenue cycle related position.

• Requires knowledge of medical terminology and a basic understanding of coding and payment methodologies including DRG and APC. Individuals working with payor audits must have a keen understanding of all audit response requirements and timelines.

• Valid Kentucky Licensure as a Registered Nurse

Work Experience

Education