We Are Hiring Great opportunity to work remotely! What You Will Do: As one of our Revenue Integrity Registered Nurse Auditors, with St. Agnes Healthcare-MD, you will leverage your advanced analytical, coding and clinical experience to perform pre-bill and post-bill clinical validation reviews. Previous experience as an inpatient registered nurse is preferred along with familiarity of hospital revenue cycle and charge master terminology and practice. Responsibilities: * Networks with insurers to resolve those denial issues that can be managed successfully without appeal. * Supports the efforts of the Care Management Department through the avoidance, investigation, and appeal of denials of days of care and/or patient care services. * Serves as a resource for the care managers, insurance carriers, admitting and accounts receivable. * Provides ongoing education to ancillary departments in an effort to maximize denial management and the overturn of denied days. * Reviews admissions and service requests within assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria. * Assists departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals. Why Join Saint Agnes? Saint Agnes Healthcare serves the greater Baltimore area and employs more than 3,000 associates. Saint Agnes offers a full range of services through its operation of a 254-bed, full-service teaching hospital, Saint Agnes Medical Group, Seton Imaging Center, and Saint Agnes Foundation. Partnerships throughout the community have positioned Saint Agnes to provide support to individuals when and where they need it most. Saint Agnes strives to ensure the vitality and health of the community. Saint Agnes Healthcare is part of Ascension, a faith-based healthcare organization dedicated to transformation through innovation across the continuum of care. As one of the leading non-profit and Catholic health systems in the US, Ascension is committed to delivering compassionate, personalized care to all, especially those most in need. In FY2018, Ascension provided nearly $2 billion in care of persons living in poverty and other community benefit programs. What You Will Need: * Active RN License * Graduate of a Registered Nursing Program * Five years' clinical experience required; Med/Surg and/or ICU preferred. * Auditing experience is preferred. Prior experience with denials and appeals processing, utilization review, or payor auditing strongly preferred. * Knowledge of insurance regulations/contracts, managed care, CMS, and ER Autopay desired. Why Join Ascension? Saint Agnes Healthcare serves the greater Baltimore area and employs more than 3,000 associates. Saint Agnes offers a full range of services through its operation of a 254-bed, full-service teaching hospital, Saint Agnes Medical Group, Seton Imaging Center, and Saint Agnes Foundation. Partnerships throughout the community have positioned Saint Agnes to provide support to individuals when and where they need it most. Saint Agnes strives to ensure the vitality and health of the community. Saint Agnes Healthcare is part of Ascension, a faith-based healthcare organization dedicated to transformation through innovation across the continuum of care. As one of the leading non-profit and Catholic health systems in the US, Ascension is committed to delivering compassionate, personalized care to all, especially those most in need. In FY2018, Ascension provided nearly $2 billion in care of persons living in poverty and other community benefit programs. What You Will Do As an Associate with St. Agnes Healthcare-MD, you will have the opportunity to provide health care services regarding admissions, case management, discharge planning and utilization review. Responsibilities: * Reviews admissions and service requests within assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria. Provides case management and/or consultation for complex cases. * Assists departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals. * Assesses and coordinates discharge planning needs with healthcare team members. * May prepare statistical analysis and utilization review reports as necessary. * Oversees and coordinates compliance to federally mandated and third party payer utilization management rules and regulations. What You Will Need Licenses/Certifications/Registration: * Required Credential(s): * Registered Nurse credentialed from the Maryland Board of Nursing obtained prior to hire date or job transfer date. Education & Work Experience: * Diploma from an accredited school/college of nursing required. * Current RN license. * At least 3 years of floor nursing required. * Appeals background required. * Background in Revenue Cycle preferred. * Proficient with Microsoft Office and G-Suite. Equal Employment Opportunity We are an Equal Opportunity Employer. As an equal opportunity employer, Saint Agnes Hospital does not discriminate on the basis of race, color, national origin, sex, sexual orientation, religion, age, mental or physical disability, marital status, veterans status, military service, or any other legally protected status. Please note that Ascension will make an offer of employment only to individuals who have applied for a position using our official application. Be on alert for possible fraudulent offers of employment. Ascension will not solicit money or banking information from applicants.