Revenue Integrity DNB Specialist

Tampa General Hospital•Tampa, FL

About The Position

The Revenue Integrity Discharged Not Billed (DNB) Specialist is responsible for successful completion of accounts from the Utilization Management (UM) Discharged Not Billed (DNB) work queues. Directly responsible for managing discharged patient accounts that are awaiting authorization for final billing within the EPIC billing system. Ensures timely and accurate claim submission by reviewing and resolving accounts in the DNB work queue by identifying billing holds and collaborating with clinical and Revenue Cycle teams to facilitate clean claim submission resulting in denial avoidance. Works with all respective departments to evaluate trends, recommend solutions, and be part of the team that works towards a resolution of errors impacting the DNB. Works with various technology, including the electronic health record (EPIC), payor software and payor portals. This role will be familiar with standard concepts, practices and procedures within the clinical areas and revenue cycle department of facilities reviewed. Plays a critical role in optimizing financial performance. Responsible for performing job duties in accordance with mission, vision and values of Tampa General Hospital.

Requirements

High School Diploma or GED
Minimum three (3) years of experience in hospital, utilization management, billing and/or managed care collections, patient financial services or revenue cycle operations.
Understanding of billing practices and operational workflows for services provided at hospital facilities assigned.
Proficiency in utilizing Microsoft Excel and other database management software.
Proven problem-solving skills with attention to detail and accuracy.
Ability to work effectively with common office software, the electronic medical records system and payor portals.
Ability to self-manage and prioritize multiple tasks.

Responsibilities

Reviews the Utilization Management (UM) Discharged Not Billed (DNB) work queue and ensures appropriate action is taken for completion of accounts from the work queue.
Reviews authorizations for validity, correct facility, LOC and LOS and ensures documentation of authorizations and all communications with payors, UM, R/I are properly documented.
Submits NOA (notification on admission), conversion notification (from OBS to IP), or concurrent reviews/clinicals on all incomplete authorization status.
Ensures all required fields are accurately completed for claims submission and DNB removal.
Ensures appropriate follow up with payers to ensure information was received and is complete.
Demonstrate decision making ability to ensure referrals to appropriate vendors, CME, UM, URN and R/I.
Responds to all correspondence from payers in a timely manner to ensure completion of authorization process.
Responsible for denial avoidance review as well as denial reviews.
Provides feedback to respective departments to close loopholes in the authorization process which result in denials.
Complete clinical information to a continuum of post-acute care providers, including follow up with providers to ensure information was received and is complete.
Utilizes department tools and resources to organize and prioritize caseload and competing priorities.
Supports the efforts of HIM, Billing and Revenue Integrity by ensuring timely, accurate and complete data entry in multiple information systems/databases.
Brings workflow barriers or issues to the attention of leadership in an expedient manner.
Maintains excellent working relationships with payers.
Works closely with Revenue Integrity, Coding, and Utilization Review teams to address claim discrepancies.
Coordinates with UM, CM, finance, and clinical teams to resolve outstanding items preventing claim release.
Track and report on the status of DNB accounts and key performance indicators.
Identify and suggest process improvements to reduce DNB backlog and improve cash flow.
Participate in departmental meetings and training sessions to stay current with best practices and system updates.
Works as a member of the team to provide services and achieve goals. As needed, may oversee special projects and other duties as assigned.