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Job Details

Revenue Integrity Auditor- Nursing WFH

Company name
Parallon Business Solutions

Location
Nashville, TN

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Revenue Integrity Auditor- Nursing (WFH)','10251-1859','United States-Tennessee-Nashville-Capitol View Bldg 1600','Full-time','Quality Risk & Safety','!*!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. 

Key Interactions –

Corporate Revenue Integrity Leadership, Shared Services Center Directors,

Revenue Integrity staff, Facility Administration and/or ancillary department

directors.

 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','!*!Bachelors or Associate Degree in

NursingPrior

healthcare experience requiredPrior clinical and/or coding background

preferredPrior HCA SSC Revenue Integrity

preferredLPN, LVN or RN required

 

#ParallonBCOM

','Revenue Integrity Auditor- Nursing (WFH)

Company info

Parallon Business Solutions
Website : http://parallon.com

Company Profile
Parallon’s roots are in the hallways of some of America’s top-performing hospitals and our commitment is to bring the expertise we have gained as operators to help you drive results. Parallon is dedicated to helping hospitals and health systems operate knowledgeably, intelligently, effectively and efficiently in the rapidly evolving healthcare marketplace, today and in the future.

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