Revenue Integrity Coordinator

Lifepoint Health • Las Cruces, NM

4d

About The Position

As a Revenue Integrity Coordinator, joining our team, you’re embracing a vital mission dedicated to making communities healthier ®. Join us on this meaningful journey where your skills, compassion and dedication will make a remarkable difference in the lives of those we serve. This position is responsible for coordinating Revenue Integrity Compliance throughout the facility. It involves analyzing and resolving specific billing edits that require clinical expertise and that are delaying claims from processing, verifying and/or correcting billing data for accuracy and completeness, identifying charging, coding or clinical documentation issues and working with appropriate leadership and ancillary departments to resolve issues timely. The role also includes performing charge audits, providing feedback and/or education to department directors, verifying observation hours, performing charge audit/entry for departments as assigned, serving as a liaison between the SSC Charge Master Department and the facility ancillary department directors, reviewing regulation communications and implementing changes as needed, participating in facility Compliance Meetings and billing education, assisting/coordinating audits, working queues and reports, maintaining facility industrial accounts, assisting in orientation of new clinical directors, assisting with medical necessity denials, creating CDM requests, and completing required reporting. The role provides validation reviews, audits, documentation and training for the area of knowledge, sharing information with Finance, Medical Records and other revenue producing areas or departments.

Requirements

• A minimum of two (2) years of experience in a healthcare setting is preferred.
• Critical thinking skills, time management skills, decisive judgement and the ability to work with minimal supervision.
• Effective human relation skills are required for interfacing with team members, all levels of staff, physicians, patients, families and other contacts.
• Must have strong interpersonal, oral and written communication skills.
• Must have a positive attitude and even temperament in stressful or conflicting situations.
• Computer Skills, Calculator, familiarity with Medical Terminology
• Knowledge of Medicare/Medicaid, Managed Care and associated commercial payers and their respective compliance requirements.
• Revenue Cycle experience, understanding of CDM and knowledge of internal auditing techniques.

Responsibilities

• Determines the appropriateness of patient charges and Chare Description Master (CDM) assigned HCPCS/CPT coding by reviewing the medical record, facility protocols and other applicable documentation.
• 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 LifePoint standards.
• Combines or splits accounts as appropriate.
• Serves as a liaison between the HSC, facility Administration, Parallon SSC and ancillary department directors regarding charging issues, clinical documentation issues and revenue opportunities.
• Provides audit results and develops and coordinates educational in-services for facility staff related to charging/billing.
• Coordinates/performs retrospective, concurrent, patient requested and/or external billing audits.
• Analyze and resolve specific billing edits that require clinical expertise and that are delaying claims from processing in Patient Accounting and/or facility system.
• Verification and/or correction of billing data for accuracy and completeness by following regulatory requirements and reviewing the medical record, facility protocol and other applicable documentation and application of modifiers and/or condition codes as appropriate.
• Identify charging, coding or clinical documentation issues and work with appropriate leadership and ancillary departments to resolve issues timely.
• Perform charge audits by verifying data as compared to documentation and making corrections in Patient Accounting as needed.
• Providing timely feedback and/or education to department directors when trends are identified through audits or daily duties to reduce future like errors and to reduce AR days.
• Verify observation hours daily to ensure hours are correct and any applicable carveouts have been applied.
• Charge Audit/Entry for departments as assigned.
• Serve as a liaison between the SSC Charge Master Department and the facility ancillary department directors.
• Review LifePoint regulation communications, applicable CMS transmittals and Local Coverage Decisions (LCD).
• Assess impact to Revenue Integrity procedures and implement changes as needed.
• Participate in facility Compliance Meetings.
• Participate in billing education, webcasts and conference calls as required.
• Assist/Coordinate LifePoint Quarterly Charge SOX Audits to ensure timely completion and submittal through the CAT Tool.
• Work Parallon Erequest Queue’s or edits as assigned and Daily Batch Report.
• Work Daily Charge Recon, Charge Exception and Daily Revenue Reports.
• Maintain facility industrial accounts.
• Performs Quarterly Compliance Audit and submit via CAT Tool as required by HSC.
• Assist in orientation of new clinical directors regarding charging processes and charge reconciliation.
• Assist PFSD with medical necessity denials as needed.
• Create CDM requests for all departments.
• CDM Gatekeeper.
• Complete required monthly and year end reporting as requested.
• Perform other related functions or duties as assigned.

Benefits

• Multiple levels of medical, dental and vision coverage for full-time and part-time employees.
• Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off.
• Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match.
• Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs).
• Ongoing learning and career advancement opportunities.

What This Job Offers

• Career Level: Mid Level
• Education Level: No Education Listed