Billing Integrity Analyst RN

HCA Healthcare • Nashville, TN

152d

About The Position

The Billing Integrity Analyst Registered Nurse (RN) is responsible for determining the appropriateness of patient charges, and Charge Description Master (CDM) assigned HCPCS/CPTs, by reviewing the medical record, facility protocol, and other applicable documentation. This review includes 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, Relay Health or the payer. Applies modifiers when appropriate based on this review, 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. Uses clinical expertise when applicable to perform charge reviews and/or works on edits that are deemed appropriate for only an RN to be qualified to review and resolve. Combines or splits accounts as appropriate. Serves as a liaison between facilities Administration, Shared Services Center, and ancillary department directors regarding charging issues, clinical documentation issues and revenue opportunities. Provides charge review results and develops and coordinates educational in-services for facility staff related to charging/billing issues. Coordinates retrospective, concurrent, patient requested, and external billing audits. Reviews denial trends for documentation and charging opportunities. Serves as a primary contact for charge related SSC and facility inquiries and issues.

Requirements

• RN or other advanced nursing degree required.
• Knowledge of CPT/HCPCS codes or experience in charging or performing charge reviews.
• Healthcare experience in an acute care hospital or coding experience preferred.
• Active Registered Nurse License or other advanced nursing license required. Compact license for all states accepted.

Responsibilities

• Analyze and resolve specific billing edits that require an RNs clinical expertise and that are delaying claims from processing in the Patient Accounting and/or Relay Health systems.
• Verify (and/or correct) billing data for accuracy and completeness, by following regulatory requirements, and reviewing the medical record, facility protocol, and other applicable documentation.
• Apply modifiers and condition codes, as appropriate.
• Identify charging, coding, or clinical documentation issues and work with appropriate leadership and ancillary departments to resolve issues.
• Perform charge audits reviews by verifying billing data as compared to documentation and making corrections in Patient Accounting as needed.
• Analyze charge review findings, provide recommendations to facility ancillary department directors in order to improve documentation, charging flow, and accuracy.
• Serve as chargemaster liaison to facilitate clinical department education on appropriate charging of CPT codes, Revenue Codes, and communicating with Ancillary Departments to resolve issues.
• Perform assigned charge reviews (governmental, corporate, insurance defense, patient requested, collections, denials, focused review, SPAEs, cosmetics, etc.) by researching documentation, analyzing information, entering all corrections as needed and communicating error trends to provide process improvement opportunities.
• Review Regulatory and Compliance Communications, applicable CMS transmittals, and Local Coverage Decisions (LCD). Assess impact to Billing Integrity procedures and implement changes as needed.
• Participate in customer service events at the facility such as facility FECC Committee, new director onboarding, charge education and report charging issues as appropriate.
• Maintain billing education, attend webcasts and conference calls as required.

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Hospitals
• Education Level: Bachelor's degree