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Revenue Integrity Registered Nurse Team Lead Remote in San Antonio at Parallon

Date Posted: 6/8/2019

Job Snapshot

Job Description

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.
Job Summary – The Revenue Integrity Team Lead (Clinical) is responsible for assisting Revenue Integrity Leadership with quality assessment and training of the clinical Revenue Integrity Department Staff. Performs internal quality assessment reviews on all Revenue Integrity Analysts to ensure compliance with Company policies. Monitor and assist staff with claims in RI workflow tools for timely resolution resulting in appropriate reimbursement and data integrity.
Duties (included but not limited to):
• Perform on-going quality assessments for the clinical staff in the Revenue Integrity Department to ensure accurate completion of accounts being held due to Company or payer edits according to Federal and Company regulations
• Act as a resource to clinical Revenue Integrity Analysts for complicated cases, reimbursement and compliance information
• Assist RI Management with trending patterns and identifies training and educational opportunities
• Assist RI Managers in developing action plans for RI Analyst improvement.
• Assist Revenue Integrity Managers by delivering standardized approved training and education to the Revenue Integrity Analysts
• Assist in the development of standardized tools, resources and policies and procedures
• Openly communicate issues and opportunities to appropriate person(s)
• Assist management with monitoring of claim volumes in RI workflow tools to ensure accurate and timely resolution.
• Conduct new clinical analyst orientation and training
• Work account edits as needed
• Escalate issues appropriately
• Meet all educational requirements as assigned by management and HCA
• Maintain up-to-date knowledge of regulatory changes impacting charging practices
• Meets with the RI Manager regularly to effectively communicate and resolve issues, set and prioritize goals, improve processes and review department reports
• Assists with staff communication, providing updates, resolving issues, setting goals and maintaining standards
• Assist the Manager in maintaining established departmental policies and procedures, objectives, patient, and customer service policies
• Perform quality reviews as required by Parallon/SSC policy.
• Work as a liaison between team members and SSC staff  
• Assist with payroll activities for team members (i.e., time cards, edit sheets)
• Assist manager with developing team goals and action plans
• Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement”
• Other duties as assigned

Job Requirements

Organization - proactively prioritizes needs and effectively manages resources
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
Leadership - guides individuals and groups toward desired outcome by providing training, advice and feedback to assist/support employees in achieving established performance standards
Tactical execution - assist in monitoring operational processes and making recommendations for changes/adjustments as needed during the implementation or change to new products or processes
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.
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 charge reviews

CERTIFICATE/LICENSE - Active Registered Nurse License or other advanced nursing license required



Parallon/HCA is an equal opportunity workforce and no one shall discriminate against any individual with regard to race, color, religion, sex, national origin, age, disability, sexual orientation, gender identity or expression, genetic information or veteran status with respect to any offer, or term or condition, of employment. We make reasonable accommodations to the known physical and mental limitations of qualified individuals with disabilities.


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