Revenue Integrity Auditor- Nursing in Nashville, TN at Parallon

Date Posted: 2/28/2018

Job Snapshot

Job Description

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 – Evaluates medical record documentation for evidence of clinical information to support charges, observation hours, status orders, charge orders etc. Coordinates with facility as needed to obtain missing documentation when applicable. Ability to associate clinical and coding information to national and local coverage determination. Audits the appropriateness of patient charges, and Charge Description Master (CDM) assigned HCPCS/CPT coding, by reviewing the medical record, facility protocol, and other applicable documentation. The reviews may include 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, SSI or the payer. Audit that modifiers applied are appropriate based upon reviews, 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. Evaluates if account combinations and account splits are appropriately applied. Serves as a liaison between, Corporate Revenue Integrity Leadership, Facility Administration, Shared Services Center, and ancillary department directors regarding charging issues, clinical documentation issues and revenue education opportunities. Provides audit results and works with Revenue Integrity Education Director to develop and coordinates educational in-services for SSC, or facility staff related to charging/billing issues. Coordinates audits for retrospective or concurrent, corporate special projects, and other billing reviews as identified. Reviews denial trends for documentation and charging opportunities and provides feedback on educational gaps. Serves as a primary contact for charge and billing related corporate initiated audits. Provides feedback to the Revenue Integrity Education Director on key educational opportunities based on audit findings

Duties (included but not limited to)  

  • Perform corporate audits of charging, coding, or clinical documentation and work with Corporate Revenue Integrity Leadership to provide audit results and education.
  • Perform charge audits by verifying billing data as compared to documentation and making corrections in Patient Accounting as needed. By analyzing audit findings, recommendations are made to corporate Revenue Integrity Leadership, SSC Revenue Integrity Leadership, facility ancillary department directors in order to improve documentation, charging flow, and accuracy.
  • Review HCA Regs Communications, applicable CMS transmittals, and Local Coverage Decisions (LCD). Assess impact to Revenue Integrity procedures and implement changes as needed.
  • Maintain billing education; attend webcasts and conference calls as required.
  • Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement”
  • Perform other related functions as assigned

Job Requirements

  • Bachelors or Associate Degree in Nursing
  • Prior healthcare experience required
  • Prior clinical and/or coding background preferred
  • Prior HCA SSC Revenue Integrity preferred
  • LPN, LVN or RN required