Revenue Utilization Review (RUR) Nurse

Summary The Consolidated Patient Accounts Center (CPAC) is a regionally consolidated business entity established to enhance revenue operations throughout the VHA network by standardization and consolidation of functions, and the integration of VHA and industry best standards. The Revenue Utilization review (RUR) Registered Nurse (RN) is an active member of the revenue cycle program and functions within the scope of the CPAC. Responsibilities Responsibilities of the RUR nurse include, but are not limited, to the following: Serves as a patient advocate providing accurate and timely clinical information to third-party payers. Ensures compliance with established third-party payer criteria for reimbursement and appeal of clinical denials. Provides feedback as appropriate, for performance improvement, utilization management, and compliance related issues. Conducts precertification with third party-payers including VA and Community Care as applicable. Validates Service Connection (SC)/Special...

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