Revenue Integrity Analyst RN
Location: Terre Haute
Posted on: July 11, 2019
DESCRIPTION SHIFT: Work From Home
REVENUE INTEGRITY ANALYST RN - WORK FROM HOME - FULL TIME
Parallon believes that organizations that continuously learn and
improve will thrive. That's 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 industry's leading providers of business
and operational services, Parallon is uniquely equipped to provide
a broad spectrum of customized revenue cycle services.
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
DUTIES (INCLUDED BUT NOT LIMITED TO)
Analyze and resolve specific billing edits that require a 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
Perform charge audits reviews by verifying billing data as compared
to documentation and making corrections in Patient Accounting as
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
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
RN or other advanced nursing degree required
Healthcare experience in an acute care hospital or coding
experience preferred. Knowledge of CPT/HCPCS codes or experience in
charging or performing charging validation reviews.
Active Registered Nurse License or other advanced nursing license
We offer training support, competitive salary and excellent
benefits to include several insurance package options for Medical,
Dental and Vision; Paid Time Off for vacation, sick leave and
holidays, Employer-paid Short Term Disability, Company matching
401K and more!
Parallon is an Equal Opportunity Employer (EOE), minority/ female/
veteran/ disabled, offering a great work environment, challenging
career opportunities, and competitive compensation.
Keywords: Parallon, Terre Haute , Revenue Integrity Analyst RN, Healthcare , Terre Haute, Indiana
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