Revenue Integrity Coordinator

Lifepoint Health • Las Cruces, NM

4d • Onsite

About The Position

Your experience matters Memorial Medical Center is part of Lifepoint Health, a diversified healthcare delivery network with facilities coast to coast. We are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others. 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.

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.
• This review includes verification of billing data for accuracy and completeness, following regulatory requirements in order to resolve edits or exceptions detected during system processing of the claims in Patient Accounting, HMS 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 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.
• Coordinate Revenue Integrity Compliance throughout the facility through the following: 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.
• By analyzing audit findings recommendations are made to facility ancillary department directors in order to improve documentation, charge flow and accuracy.
• 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.
• 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.

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

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed