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Revenue Integrity Compliance Manager in Nashville at Parallon

Date Posted: 12/6/2018

Job Snapshot

Job Description

Revenue Integrity Compliance Manager
 
Parallon believes that organizations that continuously learn and improve will thrive. That’s why after more than a decade Parallon remains 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.
 
Job Summary - The Corporate Revenue Integrity and  Chargemaster Compliance Manager for Parallon Business Performance Group (“BPG”) is primarily responsible for supporting adherence to HCA chargemaster standards and billing compliance initiatives for new acquisitions as a member of the Parallon Corporate Compliance team. The Manager must be able to support BPG with knowledge of billing regulations, coding regulation as well as Medicare and other payor specific regulations. This individual will work collaboratively with cross functional teams to support new acquisitions to conduct appropriate chargemaster mapping and compliance with HCA standards. In addition the Manager will serve as subject matter expert to support appropriate revenue capture education and monitoring for new acquisitions. The manager will evaluate charge capture practices and prepare corrective actions, including educational opportunities, mapping opportunities, and communicating these activities to the Leadership at BPG Corporate Compliance.  The individual will participate in acquisition teams and serve as the subject matter expert of Chargemaster mapping activities as well as compliance to Regs standards.  The Manager will support the Parallon revenue capture analysis and prebill capture program. This program will be responsible for capturing potential revenue capture that is compliant with billing and Medicare regulation in addition to being compliant with HCA billing and coding guidance.
 
This individual must demonstrate a strong commitment to stakeholder relationships by taking ownership of issues and facilitating effective outcomes in a timely manner. They must have an extensive background in hospital coding, billing and regulatory requirements, CPT/HCPCS, Revenue Codes and managing professional resources. This individual must have a strong understanding of system integration and revenue cycle.
 
 
Duties:

  • Compare Chargemaster of acquisition facility to HCA Regs standards and map the acquisition to meet standards
  • Support acquisitions with oversight of all chargemaster related activities including monitoring deadlines and compliance mapping to HCA standards (25% travel possible pending on acquisition activity).
  • Utilize data analytics to help support compliance monitoring of chargemaster for new acquisitions in addition to evaluating appropriate revenue capture analytics.
  • Communicate relevant company billing and coding decisions to all relevant parties in response to acquisition management; including but not limited to action plan management.
  • Responsible for maintaining positive relationships with key stakeholders including but not limited to CRM team, Corporate Compliance team, Corporate Functional Area Leaders, HIS team, IT&S team, Regs, SSC Leadership, ECOs, CDM Managers, RI Leadership, project management.
  • Support Company strategy for masterfile mapping standardization.
  • Perform prebill charge capture review.
  • Work closely with HCA Corporate Regs team to ensure compliance with billing and coding standards.
  • Perform education to with ancillary department leaders and other key stakeholders as identified related to HCA standards and billing guidelines.



Job Requirements

EDUCATION

  • Bachelor’s Degree in Business or related field required. 
  • Equivalent work experience may substitute education requirements.


 
EXPERIENCE

  • Minimum five years’ experience in related area with two of these years being healthcare management experience OR completion of the Parallon Manager Trainee Program.
  • Charge Master or Chart/Bill audit experience preferred
  • Experience with the  HCA Patient Accounting, Artiva/ Collections, Meditech, and Smart software is a plus


 
CERTIFICATE/LICENSE

  • RHIT, CCS, CCP,CPC or other recognized AHIMA certified coding credential; other healthcare related credential such as (but not limited to) LPN, LVN or RT preferred