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Revenue Integrity Analyst Nurse

Company: HCA.
Location: Largo
Posted on: September 9, 2019

Job Description:

Description SHIFT: Work From Home

SCHEDULE: Full-time

Parallon believes that organizations that continuously learn and improve will thrive. Thats why, after more than a decade, we remain dedicated to helping hospitals and hospital systems operate knowledgeably, intelligently, effectively and efficiently in the rapidly evolving healthcare marketplace, today and in the future. As one of the healthcare industrys leading providers of business and operational services, Parallon is uniquely equipped to provide a broad spectrum of customized revenue cycle services. Job Summary The Revenue Integrity Analyst Register Nurse (RN) is responsible for determining the appropriateness of patient charges, and Charge Description Master (CDM) assigned HCPCS/CPTs, 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, Relay Health 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. Uses clinical expertise when applicable to perform charge reviews and/or works on edits that are deemed appropriate for only an RN to be qualified to review and resolve. Combines or splits accounts as appropriate. Serves as a liaison between facilities Administration, Shared Services Center, and ancillary department directors regarding charging issues, clinical documentation issues and revenue opportunities. Provides charge review 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.
Supervisor Revenue Integrity Manager
Supervises not applicable
Duties (included but not limited to):
Analyze and resolve specific billing edits that require an RNs clinical expertise and that are delaying claims from processing in the Patient Accounting and/or Relay Health 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 reviews by verifying billing data as compared to documentation and making corrections in Patient Accounting as needed.
Analyze charge review findings, provide recommendations to facility ancillary department directors in order to improve documentation, charging flow, and accuracy.
Serve as chargemaster liaison to facilitate clinical department education on appropriate charging of CPT codes, Revenue Codes, and communicating with Ancillary Departments to resolve issues. Coordinates updates (activate, inactivate, modification) with Ancillary Departments as necessary
Performs assigned charge reviews (governmental, corporate, insurance defense, patient
requested, collections, denials, focused review, SPAEs, cosmetics, etc.) by researching
documentation, analyzing information, entering all corrections as needed and
communicating error trends to provide process improvement opportunities.
Review Regulatory and Compliance Communications, applicable CMS transmittals, and
Local Coverage Decisions (LCD). Assess impact to Revenue Integrity procedures and
implement changes as needed. Perform NCD LCD Coverage review when requested.
Participate in customer service events at the facility such as facility FECC Committee, new
director onboarding, charge education 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.
Other duties as assigned Qualifications KNOWLEDGE, SKILLS & ABILITIES
Communication - communicates clearly and concisely, verbally and in writing. This includes
utilizing proper punctuation, correct spelling and the ability to transcribe accurately.
Customer orientation - establishes and maintains long-term customer relationships,
building trust and respect by consistently meeting and exceeding expectations
Interpersonal skills - able to work effectively with other employees, patients and external
parties
PC skills - demonstrates proficiency in Microsoft Office applications and others as required
Policies & Procedures - demonstrates knowledge and understanding of organizational
policies, procedures and systems
Basic skills - demonstrates ability to organize, perform and track multiple tasks accurately in
short timeframes, have ability to work quickly and accurately in a fast-paced environment
while managing multiple demands, ability to work both independently and collaboratively
as a team player, adaptability, analytical and problem solving ability and attention to detail
and able to perform basic mathematical calculations, balance and reconcile figures,
punctuate properly, spell correctly and transcribe accurately.
EDUCATION
RN or other advanced nursing degree required
EXPERIENCE
Healthcare experience in an acute care hospital or coding experience preferred. Knowledge of
CPT/HCPCS codes or experience in charging or performing charge reviews
CERTIFICATE/LICENSE
Active Registered Nurse License or other advanced nursing license required

Keywords: HCA., Largo , Revenue Integrity Analyst Nurse, Healthcare , Largo, Florida

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