Revenue Integrity Analyst- LPN West Valley Medical Center

Job: Case Management

Assist in resolving billing edits that are holding patient claims from billing, by reviewing medical records and other applicable documentation. Maintain the integrity of facility Charge Description Master (CDM) and Revenue Integrity Systems Program. Maintain the integrity of all Ancillary Department systems related to billing and revenue. Position will serve as liaison between Administration, the PAS and Ancillary Department Directors regarding revenue and compliance issues. Position will coordinate all retrospective, concurrent, patient complaint and external billing audits. Provide monthly audit results. Develop and coordinate educational in-services to the Business Office staff and Ancillary staff related to charging and billing issues. Review denial trends for documentation or charging issue opportunities. Review high charge stays/procedures for charging accuracy. Ensures web tool (unbilled) items are addressed properly and timely. Serve as primary contact for all charge-related PAS inquiries and issues.

DUTIES INCLUDE BUT ARE NOT LIMITED TO

Analyzing and resolving patient claims being held by billing edits on the Bill 45, Bill 49, DET,CRT Medical necessity, Correct Coding Initiative, Outpatient Code Editor(OCE), Inpatient Code Editor, Self Administered and other claims requiring clinical expertises.

Interact with ancillary departments to obtain additional information needed to properly bill account based on medical record

Identify charging, coding, or clinical documentation issues and work with ancillary departments to resolve issues and notify appropriate leadership.

Reviews all BHL, Mutual, FCSO, PAS Billing Compliance correspondence and adheres to all guidelines

Performs assigned audits by researching documentation, analyzing information, and makes recommendations to improve flow of claim and enters all corrections into the systems:

Serves as charge master liaison to include regular reviews of CPT codes, Revenue Codes, review of monthly standard CDM error report and communicating with Ancillary Departments to resolve issues.

Member of facility FECC Committee; reports charging issues, etc.

Maintain mandated billing education (i.e. EM Assigner ), attend webcasts and conference calls per HCA Requirements.

Perform other related functions as assigned  Requirements Excellent communication skills both verbal and written

Good interpersonal skills

Able to establish good customer relationships with trust and respect.

Able to travel as needed

Computer skills: navigation and edit resolution through various Web based systems, Ability to use email, Excel, Word.

EDUCATION

Associate Degree in Nursing or LPN required. Registered Nurse preferred.

EXPERIENCE

Healthcare experience required

CERTIFICATE/LICENSE -

Current State licensure as a Registered Nurse or LPN

Parallon

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Country: USA, State: Idaho, City: Caldwell, Company: HCA Shared Services - Physician Services.