Job Information
Universal Health Services Senior Nurse Auditor in RICHMOND, Virginia
Responsibilities
One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500 corporation, annual revenues were $14.3 billion in 2023. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies.
Headquartered in King of Prussia, PA, UHS has approximately 96,700 employees and continues to grow through its subsidiaries. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom.
https://uhs.com/
The Atlantic Region CBO is seeking a dynamic and talented Senior Nurse Auditor.
The primary responsibility of the Senior Nurse Auditor is guiding individuals internally and externally to desired outcomes and providing ongoing training and supporting the team with process questions while they analyze clinical claim denials, draft detailed appeal letters, evaluate clinical level of care and review denial trends.
Key Responsibilities include:
Perform clinical reviews in response to claim denials by third party payers.
Analyze medical records to confirm medical necessity as it pertains to inpatient level of care, readmissions, patient length of stay, non-covered services, experimental and investigational issues, ER Downgrades, DRG validation and other claim denials.
Draft detailed clinical appeal letters to submit to third party payers to obtain reimbursement for denied claims.
Make decisions to downgrade inpatient claims to observation status and perform calculation of observation hours.
Assist in training with newly hired nurse auditors.
Provide support to team members with account related questions
Participates in creating and maintaining work flow processes to help nurse auditor team to be proficient in department responsibilities.
Assist team lead in reviewing and resolving complex denial scenarios.
Call third party payers and physician offices as needed to obtain additional clinical details, retro-authorization requests, and clarity on denials.
Use reporting to help identify denial trends and provide feedback to management and to UHS acute care facilities.
Adheres to all applicable laws, regulations and guidelines.
Provides clinical knowledge for CBO staff and consultation to management as needed.
Other duties as assigned.
Benefit Highlights
Retention Bonus Program if offered.
Loan Forgiveness Program if offered.
Challenging and rewarding work environment
Competitive Compensation & Generous Paid Time Off
Excellent Medical, Dental, Vision and Prescription Drug Plans
401(K) with company match and discounted stock plan
SoFi Student Loan Refinancing Program
Career development opportunities within UHS and its 300+ Subsidiaries!
More information is available on our Benefits Guest Website: benefits.uhsguest.com
Contact Information:
Nicole Baez
HR Coordinator/Recruiter
Nicole.baezRojas@uhsinc.com
Qualifications
Position Requirements:
RN or LPN licensure in good standing is required. BSN degree preferred
Three to five years of experience is preferred
CPC, CCS or other coding credentials preferred, but not required
Experience working in Patient Financial Services and an understanding of the Revenue Cycle from beginning to end is preferred.
Experience working in case management or audit with technical denials is preferred.
Strong Microsoft Office skills (Excel, Word, Outlook)
Customer focused both internally and externally, strong attention to detail, the ability to multi-task.
Excellent written and oral communication skills are required.
EEO Statement
All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.
We believe that diversity and inclusion among our teammates is critical to our success.
Avoid and Report Recruitment Scams
At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.
If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.