Revenue Integrity Analyst- RN (PRN) at Nashville

Job Description

Job: Case Management

Determines the appropriateness of patient charges, and Charge Description Master (CDM) assigned HCPCS/CPT coding, by reviewing the medical record, facility protocol, and other applicable documentation. This review includes the verification of billing data for accuracy and completeness, following regulatory requirements, in order to resolve edits or exceptions detected during system processing of the claim in Patient Accounting, SSI or the payer. Applies modifiers when appropriate based on this review, and/or makes necessary adjustments to patient account charges and/or balances. Analyzes accounts for specialized billing requirements that require a review of the medical record documentation, regulatory information, and HCA standards. Combines or splits accounts as appropriate. Serves as a liaison between facility Administration, Shared Services Center, and ancillary department directors regarding charging issues, clinical documentation issues and revenue opportunities. Provides audit results and develops and coordinates educational in-services for facility staff related to charging/billing issues. Coordinates retrospective, concurrent, patient requested, and external billing audits. Reviews denial trends for documentation and charging opportunities. Serves as a primary contact for charge related SSC and facility inquiries and issues.
DUTIES INCLUDE BUT ARE NOT LIMITED TO:
Analyze and resolve specific billing edits that require clinical expertise and that are delaying claims from processing in the Patient Accounting and/or SSI systems. This includes the verification (and/or correction) of billing data for accuracy and completeness, by following regulatory requirements, and reviewing the medical record, facility protocol, and other applicable documentation. This also includes the application of modifiers and condition codes, as appropriate.
Identify charging, coding, or clinical documentation issues and work with appropriate leadership and ancillary departments to resolve issues.
Perform charge audits by verifying billing data as compared to documentation and making corrections in Patient Accounting as needed. By analyzing audit findings, recommendations are made to facility ancillary department directors in order to improve documentation, charging flow, and accuracy.
Serve as a liaison between the SSC Charge Master department and the facility ancillary department directors
Review HCA Regs Communications, applicable CMS transmittals, and Local Coverage Decisions (LCD). Assess impact to Revenue Integrity procedures and implement changes as needed.
Participate as a member of the facility FECC Committee and report charging issues as appropriate.
Maintain billing education, attend webcasts and conference calls as required.
Practice and adhere to the Code of Conduct philosophy and Mission and Value Statement
Perform other related functions as assigned
Excellent communication skills both verbal and written
Good interpersonal skills
Able to establish good customer relationships with trust and respect
Able to travel as needed
Computer skills: navigation and edit resolution through various Web based systems. Ability to use email, Excel, Word

Job Requirements

EDUCATION
High School diploma or GED required
Undergraduate degree preferred
EXPERIENCE
Healthcare experience required
Clinical experience preferred
CERTIFICATE/LICENSE
RN
Parallon

Country: USA, State: Tennessee, City: Nashville, Company: Parallon Business Solutions.