University of Utah Health Care

  • Nurse Auditor - Medical Coding

    Requisition Number
    35476
    Reg/Temp
    Regular
    Employment Type
    Full-Time
    Shift
    Day
    Work Schedule
    M-F
    Location Name
    University of Utah Health Plans
    Patient Care?
    No
    City
    Murray
    State
    UT
    Department
    UIP CST 01H UUHP CLINICAL OPRN
    Category
    Insurance / Health Plans
  • Overview

    As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, diversity, integrity, quality and trust that are integral to our mission. EO/AA

    This position is responsible for oversight of the pended claims and auditing process at the University of Utah Health Plans. This individual will assist in developing the coding algorithms for adjudicating claims to improve efficiency in the pended claims review process and also oversee development of appropriate reimbursement policies to support adjudication of pended claims.

    Responsibilities

    • Supervise payment claim editing staff.
    • Provide direction to pended claims staff on claims adjudication questions.
    • Provide input in the development of appropriate claims edits to improve efficiency of pended claims review process.
    • Provides oversight of audit process for gold carded providers.
    • Provides input into development of reimbursement policies to support appropriate coverage of pended claims.
    • Participates in identifying and initiating assessments for fraud/waste/abuse issues related to claims submission.

    Knowledge / Skills / Abilities

    • Effective written and verbal communication skills.
    • Demonstrated ability to lead a team.
    • Demonstrated management and facilitation skills.
    • Knowledge of AMA-CPT coding guidelines/rules and correct coding initiative edits.
    • Demonstrated competency in Microsoft Word and Excel.

    Qualifications

    Qualifications

    Required

    • Five years experience as a certified coder.
    • Three years clinical RN experience.

    Licenses Required

    • Current license to practice as a Registered Nurse in the State of Utah, or obtain one within 90 days of hire under the interstate compact if switching residency to State of Utah. Must maintain current Interstate Compact (multi-state) license if residency is not being changed to Utah.

    * Additional license requirements as determined by the hiring department.

    Qualifications (Preferred)

    Preferred

    • BSN
    • Five years clinical RN experience.
    • Additional coding certification in any specialty certification or hospital coding.

    Working Conditions and Physical Demands

    Employee must be able to meet the following requirements with or without an accommodation.

    • This is a sedentary position in an office setting that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions.
    • We are University of Utah Health. Employment.utah.edu

    Physical Requirements

    Listening, Sitting, Speaking, Standing

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