Experience:
3-5 years of experience
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Employment Type:
Full time
Posted:
4/3/2019
Job Category:
Accounting
Revenue Integrity Auditor
(This job is no longer available)
Capitol View Bldg 1600 | Nashville, TN
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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.

We are a wholly owned subsidiary of HCA, a Fortune 100 company with more than 200,000 employees and one of the nation's leading providers of healthcare services, operating over 170 locally managed hospitals and over 100 freestanding surgery centers in 20 states and the United Kingdom. HCA has been named one of the world's most ethical companies for eight years in a row. At HCA, we are driven by a single goal: the care and improvement of human life.

Job Summary

Performs Charge Reviews on 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. Reviews 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 charge review 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 charge reviews 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 charge reviews. Provides feedback to the Revenue Integrity Education Director on key educational opportunities based on charge review findings.

Duties:

* Perform corporate reviews of charging, coding, or clinical documentation and work with Corporate Revenue Integrity Leadership to provide results and education.
* Perform charge reviews by verifying billing data as compared to documentation and making corrections in Patient Accounting as needed. By analyzing charge review 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.
* Participate in Corporate QA program
* Assist as needed with Corporate Audit program
* Perform analytics as needed
* Maintain billing education; attend webcasts and conference calls as required.

Education

* High School diploma or GED required
* Undergraduate degree preferred

Experience

* Prior healthcare experience required
* 1-2 years audit experience
* Prior clinical and/or coding background preferred
* Prior HCA OPPS coding, SSC Revenue Integrity and/or working knowledge of charge master experience preferred
* Understanding of Revenue Cycle Pro, 3M Coding system and 3M Coding Resources

Certificate/License

* Prefer active certification or licensure as a 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

Benefits of working at Parallon

Our benefits package allows you to select the options that best meet the needs of you and your family. Benefits include 401k with a company match, paid time off, medical, dental, vision, flex spending for both health and day care, life insurance, disability, tuition reimbursement and student loan repayment, employee discount program, employee stock purchase program.

We are an equal opportunity employer and we value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

#ParallonBCOM