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Revenue Integrity Analyst RN

Company: Parallon
Location: Mcallen
Posted on: November 6, 2019

Job Description:

Description SHIFT: Work From Home

SCHEDULE: Full-time

RevenueIntegrity Analyst RN --- Work From Home --- Full TimeParallon believesthat organizations that continuously learn and improve will thrive. That---s whyafter more than a decade we remain dedicated to helping hospitals and hospitalsystems operate knowledgeably, intelligently, effectively and efficiently inthe rapidly evolving healthcare marketplace, today and in the future. As one ofthe healthcare industry---s leading providers of business and operationalservices, Parallon is uniquely equipped to provide a broad spectrum ofcustomized revenue cycle services.JobSummaryThe Revenue Integrity AnalystRegister Nurse (RN) is responsible for determining the appropriateness ofpatient charges, and Charge Description Master (CDM) assigned HCPCS/CPTs, byreviewing the medical record, facility protocol, and other applicable documentation.-- This review includes the verification ofbilling data for accuracy and completeness, following regulatory requirements,in order to resolve edits or exceptions detected during system processing ofthe claim in Patient Accounting, Relay Health or the payer.-- Applies modifiers when appropriate based onthis review, and/or makes necessary adjustments to patient account chargesand/or balances.-- Analyzes accounts forspecialized billing requirements that require a review of the medical recorddocumentation, regulatory information, and HCA standards. Uses clinicalexpertise when applicable to perform charge reviews and/or works on edits thatare 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, clinicaldocumentation issues and revenue opportunities.--Provides charge review results and develops and coordinates educationalin-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 chargerelated SSC and facility inquiries and issues.--------Duties(included but not limited to) Analyze and resolve specific billing edits thatrequire a RNs clinical expertise and that are delaying claims from processingin the Patient Accounting and/or Relay Health systems. This includes theverification (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 ofmodifiers and condition codes, as appropriate.--Identify charging, coding, or clinicaldocumentation issues and work with appropriate leadership and ancillarydepartments to resolve issues.-- Perform charge audits reviews by verifyingbilling data as compared to documentation and making corrections in PatientAccounting as needed.---- Analyze charge review findings, providerecommendations to facility ancillary department directors in order to improvedocumentation, charging flow, and accuracy.--Serve as chargemaster liaison to facilitateclinical department education on appropriate charging of CPT codes, RevenueCodes, and communicating with Ancillary Departments to resolve issues.Coordinates updates (activate, inactivate, modification) with AncillaryDepartments as necessary Performs assigned charge reviews (governmental,corporate, insurance defense, patient requested, collections, denials, focusedreview, SPAEs, cosmetics, etc.) by researching documentation, analyzinginformation, entering all corrections as needed and communicating error trendsto provide process improvement opportunities. Review Regulatory and ComplianceCommunications, applicable CMS transmittals, and Local Coverage Decisions(LCD).-- Assess impact to RevenueIntegrity procedures and implement changes as needed. Perform NCD LCD Coveragereview when requested. Participate in customer service events at thefacility such as facility FECC Committee, new director onboarding, chargeeducation and report charging issues as appropriate. Maintain billing education, attend webcasts andconference calls as required.-- Qualifications EducationRN or other advanced nursing degree require
ExperienceHealthcare experience in an acute care hospital or codingexperience preferred.-- Knowledge ofCPT/HCPCS codes or experience in charging or performing charging validationreviews.-- Certificate/LicenseActive Registered Nurse License or other advanced nursinglicense required--We offer training support,competitive salary and excellent benefits to include several insurance packageoptions for Medical, Dental and Vision; Paid Time Off for vacation, sick leaveand holidays, Employer-paid Short Term Disability, Company matching 401K andmore!
Parallon is an Equal Opportunity Employer (EOE), minority/ female/ veteran/disabled, offering a great work environment, challenging career opportunities,and competitive compensation.--#ParallonBCOM

Company Description:

HCA Healthcare is a collaborative healthcare network, driven by physicians, nurses and colleagues helping each other champion the practice of medicine to give people a healthier tomorrow. With a comprehensive network of more than 270,000 people across approximately 1,800 care facilities, our scale enables us to deliver great outcomes for our patients, provide superior nursing care and be a preferred place for physicians to practice medicine. We never stop in our pursuit of insights and care advances based on the knowledge and data we gain from approximately 30 million patient encounters a year. Every day, we raise the bar to improve the way healthcare is delivered, not just in our facilities, but everywhere. We---re committed to improving more lives in more ways, and above all else, we are committed to the care and improvement of human life.

Keywords: Parallon, McAllen , Revenue Integrity Analyst RN, Healthcare , Mcallen, Texas

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