Revenue Integrity Nurse Specialist - Revenue Integrity - FT Exempt - 814002

Job ID
2020-3005
Category
Other
Job Location
US-NM-Alamogordo

Overview

The Revenue Integrity Nurse Specialist will be the liaison between the Revenue Integrity Team and the Clinical Department Managers to assist with ongoing maintenance of the CDM, chart- to-bill audits and charge capture processes utilizing the revenue cycle tools available. A schedule of ongoing internal audits for review and monitoring of high volume, high cost, and/or problem prone areas will be maintained by the Revenue Integrity Nurse Specialist for each designated service line. The revenue cycle audits are conducted to ensure that the clinical documentation contained within the patient chart supports the charges that appear on the patient’s bill, and to ensure the accuracy and completeness of charge capture. Where clinical documentation does not support charges appearing on the bill, the Revenue Integrity Nurse Specialist will prepare a report of exceptions and offer solutions to the applicable department. The Revenue Integrity Nurse Specialist will ensure complete and timely responses communicating the results of each audit to the Revenue Integrity Team and will work directly with the Department Managers to seek resolution and compliance. Responses to audits will come in the form of both verbal conferences and a written summary of findings. This description is not intended to be a complete list of duties. Other related duties may be assigned

Responsibilities

  • Audits and reconciles services and items documented in the patient’s chart with the patient’s bill in a timely manner to ensure accuracy and completeness of documentation and charge capture. Where exceptions are noted, suggested solutions are provided to the department and a log of activities is maintained.
  • Organizes and reconciles daily work drivers to ensure accountability of all audits assigned and to ensure CCA® batches and internal audits are worked in proper priority.
  • Recognizes that customer service and fiduciary responsibility must be balanced.
  • Reviews missing/overcharges based on CCA® data, places claims on hold and works with clinical departments to resolve.
  • Performs charge verifications to research patient complaint issues, identify patterns in patient charging errors, biller identified errors and denials of charges.
  • Works fluidly with the Revenue Integrity Team to communicate audit results and track improvement based on key performance indicators and established benchmarks. Delivers a list of exceptions to the Department needing corrective action based on CCA® and internal audit results and assists the Department with implementation.
  • Integrates and links pharmacy and supply purchase/costs with CDM data to establish markup, improve charge capture and reimbursement utilizing Hospital software.
  • Recognizes all customers, provides customer service, including full satisfaction and follow up.
  • Maintains current knowledge of hospital services; coding and billing regulations and guidelines; trends and issues affecting healthcare compliance and reimbursement.
  • Provides ongoing education and implementation support for CDM and charge capture related activities to assigned areas.
  • Assists in developing, maintaining and reporting on the Charge Description Master (CDM) for assigned areas utilizing current Hospital software.
  • Identifies and communicates opportunities to reduce hospital costs and increase efficiency while maintaining and/or improving the quality of care.

 

Qualifications

• Current New Mexico Registered Nurse (RN) License
• Coding Certification preferred.
• Strong customer service and analytical skills required.
• Understanding of coding, insurance and billing requirements. Strong working knowledge of medical terminology, patient care services, and medical record chart documentation including inpatient and outpatient.
• Working knowledge of chart/bill audits and ability to abstract medical information. Strong PC skills, specifically proficient with Microsoft Office Suite.
• Ability to work independently. Ability to complete tasks accurately and on time and to manage deadlines.
• Strong analytical, verbal and written communication skills in the English language.
• Must be reliable and dependable with consistent work attendance. Must work well with other employees. Must be able to perform critical work under deadlines.
• Must be willing to work overtime if requested by management.
• Demonstrated ability to work in a team environment that requires quick turnaround and quality output.
• Basic Life Support (BLS) certification.

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