Revenue Integrity Auditor RN

Description Introduction Last year our HCA Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a Revenue Integrity Auditor RN with Parallon you can be a part of an organization that is devoted to giving back! Benefits Parallon, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include: Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation. Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. Free counseling services and resources for emotional, physical and financial wellbeing 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service) Employee Stock Purchase Plan with 10% off HCA Healthcare stock Family support through fertility and family building benefits with Progyny and adoption assistance. Referral services for child, elder and pet care, home and auto repair, event planning and more Consumer discounts through Abenity and Consumer Discounts Retirement readiness, rollover assistance services and preferred banking partnerships Education assistance (tuition, student loan, certification support, dependent scholarships) Colleague recognition program Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence) Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income. Learn more about Employee Benefits (https://careers.hcahealthcare.com/pages/employee-benefits-and-rewards) Note: Eligibility for benefits may vary by location. Would you like to unlock your potential with a leading healthcare provider dedicated to the growth and development of our colleagues? Join the Parallon family! We will give you the tools and resources you need to succeed in our organization. We are looking for an enthusiastic Revenue Integrity Auditor RN to help us reach our goals. Unlock your potential! Job Summary and Qualifications The Revenue Integrity Registered Nurse Auditor 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. What you will do in this role: 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. Working knowledge of Medicare requirements for the “two midnight rule” Working knowledge of inpatient/outpatient status and observation Understanding of Revenue Cycle Pro, 3M Coding system and 3M Coding Resources Working knowledge of NCCI, OCE edits as well as national and local coverage determinations What qualifications you will need: Bachelors or Associate Degree in Nursing Prior healthcare experience required Prior clinical and/or coding background preferred Prior HCA SSC Revenue Integrity preferred RN required Parallon (https://parallon.com/) provides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers and their communities. HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses. "There is so much good to do in the world and so many different ways to do it."- Dr. Thomas Frist, Sr. HCA Healthcare Co-Founder Be a part of an organization that invests in you! We are reviewing applications for our Revenue Integrity Auditor RN opening. Qualified candidates will be contacted for interviews. Submit your application and help us raise the bar in patient care! We are an equal opportunity employer and 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.