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RI Analyst - Work From Home in Houston, TX at Parallon

Date Posted: 4/30/2019

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    Houston, TX
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:
    4/30/2019

Job Description

Description

SHIFT: Work From Home

SCHEDULE: Full-time

Job Summary – The Revenue Integrity Analyst (non clinical and non certified) assist in resolving billing edits that are holding patient claims from billing by reviewing medical records and other applicable documentation.   Assist in reviewing 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.  Makes necessary adjustments to patient account charges based on regulatory and payor guidelines.  Analyzes accounts for specialized billing requirements that require a review of the medical record documentation, regulatory information, and HCA standards. 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 issues.  (This is a full-time work from home opportunity).
 
Supervisor – Revenue Integrity Manager
 
Supervises – not applicable
 
Duties (included but not limited to): 
• Analyze and resolve specific billing edits that require understanding of claims level edits that are delaying claims from processing in the Patient Accounting and/or SSI 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.  
• Identify charging or clinical documentation issues and work with appropriate leadership and ancillary departments to resolve issues. 
• Review all regulatory and Parallon compliance correspondence and adheres to all guidelines
• 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
• Review HCA Regs Communications, applicable CMS transmittals, and Local Coverage Decisions (LCD).  Assess impact to Revenue Integrity procedures and implement changes as needed.  
• Participate as a member of the facility FECC Committee and report charging issues as appropriate. 
• Maintain billing education, attend webcasts and conference calls as required. 
• Maintain mandated education and attend necessary webcasts/conference calls
• Oversee assignment of observation and injection/infusion charges, as applicable to SCC
• Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement”.
• Other duties as assigned

Qualifications

KNOWLEDGE, SKILLS & ABILITIES
• 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
• 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.
 
 
EDUCATION High school diploma or GED required.
 
EXPERIENCE One year of related experience required.
 
CERTIFICATE/LICENSE  - N/A
 Work from Home Requirements

• Designated Work Area: Remote Workers are required to maintain a separate, designated work area at home

• Minimum Technical Specifications Home Internet Connectivity: Download and Upload -10Mbps
 
PHYSICAL DEMANDS/WORKING CONDITIONS Requires prolonged sitting/standing, some bending, stooping, walking and stretching. Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment. Requires normal range of hearing and eyesight to record, prepare and communicate appropriate reports or other information. Requires lifting papers/boxes and pushing/pulling up to 25  pounds occasionally. Work is performed in an office environment or hospital setting. Work may be stressful at times. Contact may involve dealing with angry or upset people. Staff must remain flexible and available to provide staffing assistance for any/all disaster or emergency situations.