Revenue Integrity Coordinator

Nashville General Hospital•Nashville, TN

15d

About The Position

Job Duties: • Interface appropriately and timely with the medical staff on documentation, medical necessity, and coding. • Provide education to department managers, employees, physicians, and others to ensure prompt, compliant documentation, and coding for optimal reimbursement. • Stay up to date on coding guidelines and federal and state regulations. Provide education to coders, physicians and hospital staff on payor changes that impact reimbursement, including changes in authorizations and billing. • Review all clinical insurance denials for validation. Use results to provide training and assist in improving processes to prevent recurring denials. • Serve on Denials Committee as an active member. Provide recommendations and participate in training. • Promptly respond (within 2 business days) to questions from physicians and departments about charging and documentation rules. Maintains logs of inquiries and recommendations. • Assist departments in understanding rules for charging and reimbursement. Manage on-going charge capture improvement initiatives. • Conduct quarterly meetings with assigned service line clinical departments to ensure accurate charge capture practices and workflows are in place: review a) RI charge capture-charge reconciliation policy, b) departments’ charge entry-charge reconciliation policy. • Facilitate charge capture related functions for new clinics, physicians, or hospital services coordinating with the department of services and with finance. • Regularly review and update charge capturing related policies and procedures for assigned clinical areas. • Assist HIM management, as needed, with the productivity and accuracy rates of Coding personnel and vendors; In coordination with the HIM Management Performs quarterly compliance reviews to determine if appropriate documentation and coding accuracy exists; identifies opportunities for improvement, prepares and delivers educational sessions to all necessary departments based on findings. [in coordination with Compliance Officer] • Assist in the development and maintenance of current policies and procedures for revenue integrity. • Assist in review of Medicare, Medicaid, Recovery Audit Contractor (RAC), and other third-party audits for coding and DRG changes, and /or denial letters. • Assist and manage challenging coding inquiries and interacts with physician advisors and other departments to efficiently troubleshoot and resolve issues. • Prioritize and assist with special project requests and perform complex research and analysis of clinical documentation, reimbursement, and coding issues. • Apply coding knowledge to clinical and reimbursement policies, procedures, laws, and regulation; may be called upon by the Privacy Officer to assist in analysis and reporting. • Perform data quality reviews ensuring revenue integrity and coding compliance by rendering monthly retrospective audits to ensure OIG compliance. Ensure compliance with all federal regulations with NCD’s and LCDs for medical necessity. • Integrate medical coding and reimbursement rules as part of retrospective review process to standardize coding and billing processes to include CDM maintenance. • Act as resource for: proper diagnosis codes with appropriate CPT codes for billing purposes, to include condition codes, modifiers, and standard billing rules for claim processing and reimbursement. Assists with the reviews for accurate medical codes for diagnosis, procedures, service, and provider specialty standards. • Participate on committees, as needed, representing areas of charge integrity, reimbursement, coding, billing compliance. • Assist with Revenue Cycle projects as needed

Requirements

High School Diploma (Equivalent) or Higher Required
Education/training in healthcare revenue cycle related coursework.
Specific education in areas of coding and reimbursement.
Certified hospital, inpatient coding is essential—CIC (Certified Inpatient Coder).
Must have at least 2 years’ experience in full revenue cycle processes.
Emphasis on reimbursement methodologies, managed care, and government rules and regulations for processing claims.
Extensive experience in charge master maintenance is necessary.

Nice To Haves

Bachelors Preferred
Other certification in areas of revenue cycle preferred (such as CRCR, CPMA). [HFMA.org, AAPC.org]
Experience in payor contract audits a plus

Responsibilities

Interface appropriately and timely with the medical staff on documentation, medical necessity, and coding.
Provide education to department managers, employees, physicians, and others to ensure prompt, compliant documentation, and coding for optimal reimbursement.
Stay up to date on coding guidelines and federal and state regulations.
Provide education to coders, physicians and hospital staff on payor changes that impact reimbursement, including changes in authorizations and billing.
Review all clinical insurance denials for validation.
Use results to provide training and assist in improving processes to prevent recurring denials.
Serve on Denials Committee as an active member.
Provide recommendations and participate in training.
Promptly respond (within 2 business days) to questions from physicians and departments about charging and documentation rules.
Maintains logs of inquiries and recommendations.
Assist departments in understanding rules for charging and reimbursement.
Manage on-going charge capture improvement initiatives.
Conduct quarterly meetings with assigned service line clinical departments to ensure accurate charge capture practices and workflows are in place: review a) RI charge capture-charge reconciliation policy, b) departments’ charge entry-charge reconciliation policy.
Facilitate charge capture related functions for new clinics, physicians, or hospital services coordinating with the department of services and with finance.
Regularly review and update charge capturing related policies and procedures for assigned clinical areas.
Assist HIM management, as needed, with the productivity and accuracy rates of Coding personnel and vendors; In coordination with the HIM Management Performs quarterly compliance reviews to determine if appropriate documentation and coding accuracy exists; identifies opportunities for improvement, prepares and delivers educational sessions to all necessary departments based on findings. [in coordination with Compliance Officer]
Assist in the development and maintenance of current policies and procedures for revenue integrity.
Assist in review of Medicare, Medicaid, Recovery Audit Contractor (RAC), and other third-party audits for coding and DRG changes, and /or denial letters.
Assist and manage challenging coding inquiries and interacts with physician advisors and other departments to efficiently troubleshoot and resolve issues.
Prioritize and assist with special project requests and perform complex research and analysis of clinical documentation, reimbursement, and coding issues.
Apply coding knowledge to clinical and reimbursement policies, procedures, laws, and regulation; may be called upon by the Privacy Officer to assist in analysis and reporting.
Perform data quality reviews ensuring revenue integrity and coding compliance by rendering monthly retrospective audits to ensure OIG compliance.
Ensure compliance with all federal regulations with NCD’s and LCDs for medical necessity.
Integrate medical coding and reimbursement rules as part of retrospective review process to standardize coding and billing processes to include CDM maintenance.
Act as resource for: proper diagnosis codes with appropriate CPT codes for billing purposes, to include condition codes, modifiers, and standard billing rules for claim processing and reimbursement.
Assists with the reviews for accurate medical codes for diagnosis, procedures, service, and provider specialty standards.
Participate on committees, as needed, representing areas of charge integrity, reimbursement, coding, billing compliance.
Assist with Revenue Cycle projects as needed