Job summary
Job post source
This job is directly from Elevate Patient Financial Solutions®
Job overview
The Nurse Auditor role at Elevate Patient Financial Solutions® involves auditing medical records and preparing appeal letters to support billing and reimbursement processes, impacting the accuracy and justification of patient care levels.
Responsibilities and impact
The Nurse Auditor will perform audits on authorization denials, medical necessity denials, DRG downgrades, MAC & RAC audits, payer utilization review audits, and charge audits, preparing clinical appeal letters based on medical record evidence to support or contest denials.
Compensation and benefits
The position offers comprehensive benefits including medical, dental, and vision insurance, 401K with matching contributions, paid time off including holidays and floating holidays, pet insurance, and an employee referral bonus program.
Experience and skills
Candidates must have utilization review and case management experience, be familiar with InterQual and/or MCG, have inpatient clinical experience, and be a Registered Nurse or Licensed Vocational Nurse; remote work requires a suitable home internet connection.
Career development
The company offers career growth opportunities allowing employees to gain experience and promote to higher roles within the organization.
Work environment and culture
Elevate Patient Financial Solutions® values teamwork and fun, emphasizing a positive impact on employees and fostering a supportive work environment.
Company information
Elevate Patient Financial Solutions® specializes in billing and reimbursement services, focusing on patient financial solutions with a commitment to employee well-being and industry impact.
Job location and travel
This is a remote-based full-time position with a schedule of 8am-5pm, Monday through Friday.
Unique job features
The role is distinguished by its focus on specialized audits and clinical appeal letter preparation using tools like InterQual and MCG, supporting complex billing and reimbursement decisions.
Company overview
Elevate Patient Financial Solutions® (ElevatePFS) is a revenue cycle management (RCM) company that partners with hospitals, health systems, and healthcare providers across the United States to streamline financial operations and improve cash flow. Founded in 1980 and headquartered in Spring, Texas, ElevatePFS employs approximately 2,750 people. The company offers a range of services, including accounts receivable follow-up, third-party liability, and veterans administration claims management. Originally known as MedData, ElevatePFS has grown through acquisitions, including Professional Medical Services, Revenue Masters, DECO, and RevClaims, to expand its service offerings and enhance its technological capabilities.
How to land this job
Position your resume to highlight your nursing background with a focus on utilization review, case management, and experience with InterQual or MCG tools, as these are key for the Nurse Auditor role at Elevate Patient Financial Solutions®. Emphasize your skills in preparing clinical reconsideration and appeal letters, as well as your familiarity with inpatient clinical experience and denial reviews including authorization, medical necessity, DRG downgrades, and payer utilization audits. Apply through multiple platforms such as Elevate Patient Financial Solutions® corporate career page, LinkedIn, and other job boards that list this position to maximize your exposure. Connect on LinkedIn with current employees in the billing and reimbursement or clinical audit divisions at Elevate Patient Financial Solutions®, using ice breakers like commenting on recent company initiatives in patient financial solutions or asking about their experience working remotely in the Nurse Auditor role. Optimize your resume for ATS by incorporating keywords from the job description such as 'Nurse Auditor,' 'utilization review,' 'InterQual,' 'MCG,' 'clinical appeal letters,' and 'inpatient clinical experience' to pass automated screenings effectively. Utilize Jennie Johnson's Power Apply feature to automate applying through multiple channels, tailor your resume for ATS, and identify relevant LinkedIn connections, allowing you to focus your time on networking and interview preparation.
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