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Revenue Integrity Auditor- Nursing WFH

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

 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
healthcare experience requiredPrior clinical and/or coding background
preferredPrior HCA SSC Revenue Integrity
preferredLPN, LVN or RN required


','Revenue Integrity Auditor- Nursing (WFH)

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