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Shriners Children’s is an organization that respects, supports, and values each other. Named as the 2025 best mid-sized employer by Forbes, we are engaged in providing excellence in patient care, embracing multi-disciplinary education, and research with global impact. We foster a learning environment that values evidenced based practice, experience, innovation, and critical thinking. Our compassion, integrity, accountability, and resilience define us as leaders in pediatric specialty care for our children and their families.

All employees are eligible for medical coverage on their first day! In addition, upon hire all employees are eligible for a 403(b) and Roth 403 (b) Retirement Saving Plan with matching contributions of up to 6% after one year of service. Employees in a FT or PT status (40+ hours per pay period) will also be eligible for paid time off, life insurance, short term and long-term disability and the Flexible Spending Account (FSA) plans and a Health Savings Account (HSA) if a High Deductible Health Plan (HDHP) is elected. Additional benefits available to FT and PT employees include tuition reimbursement, home & auto, hospitalization, critical illness, pet insurance and much more! Coverage is available to employees and their qualified dependents in accordance with the plans. Benefits may vary based on state law.

The Revenue Integrity Auditor is responsible for auditing documentation and charges to ensure compliance with all State and Federal guidelines and regulations, and providing feedback to hospital charging departments on documentation, charges and charge master coding. Researches billing issues and prepares relevant educational materials.

• Performs detailed Hospital, Ambulatory Surgery Center, and Outpatient Clinic Audits to ensure all charges have been captured and are supported by orders and appropriate documentation
• Reviews audit findings with the Hospital, ASC, and Outpatient Clinic representatives and provides opportunity for a response.
• Follows up on re-audits in a timely fashion to ensure that cases are completed.
• Performs special audits throughout the year as requested; provides executive summaries of all audit results to the appropriate departments.
• Demonstrates tact and understanding in handling problems, has a good rapport with hospital and corporate staffs.
• Provides education based on billing and compliance issues identified and at the request of individual facilities, administration and management utilizing SHINE modules, webinars, PowerPoints, Bulletins, newsletter, etc as needed throughout the year.
• Researches billing issues and compliance concerns utilizing federal and state health-care related rules and regulations and major healthcare payor policies and guidelines in order to ensure compliance with the law.
• Updates status of all cases assigned on minimum weekly basis.
• Informs director of any changes, problems, or concerns that arise at a facility.
• Re-checks mathematical computations before finalizing letter and report.
• Reviews documentation to ensure that services typically performed with specific procedures are being documented so that charge capture may occur.

This is not an all-inclusive list of this job’s responsibilities. The incumbent may be required to perform other related duties and participate in special projects as assigned.

Required:

• Working experience with Utilization Review activities and general knowledge of JCAHO, PRO, HCFA, and other regulatory bodies.
• Proficient in criteria sets used to determine eligibility for acute care hospitalization.
• Knowledge of third party payer review, reimbursement systems and utilization monitoring requirements for acute care facilities.
• Working knowledge of MS Office and 3M System
• Associate's Degree in Nursing
• RN license in State of Practice

Preferred:

• 3 years of clinical experience in a healthcare environment
• Experience reviewing hospital claims, denials and EOB's, appealing claims and working on claims in an audit