Nurse Auditor - Revenue Integrity
Company: Parkland Health and Hospital System (PHHS)
Location: Dallas
Posted on: April 16, 2024
Job Description:
Interested in a career with both meaning and growth? Whether
your abilities are in direct patient care or one of the many other
areas of healthcare administration and support, everyone at
Parkland works together to fulfill our mission: the health and
well-being of individuals and communities entrusted to our care. By
joining Parkland, you become part of a diverse healthcare legacy
that's served our community for more than 125 years. Put your
skills to work with us, seek opportunities to learn and join a
talented team where patient care is more than a job. It's our
passion.Primary PurposeResponsible for ensuring the integrity of
the hospital's patient care/services billings and preventing
revenue loss. Responsible for preparing, completing, and reporting
data required to obtain appropriate reimbursement from payers.
Responsible for compliance with governmental payer requirements
through preparation of chart audit reports and process monitoring
to reflect facility and department activities.Minimum
SpecificationsEducation
- Must be a graduate from an accredited school of nursing,
or
- Graduate of approved LVN program.Experience
- Must have four years of nursing experience, to include one year
of auditing experience.
- At least two years minimum experience in healthcare finance, or
CDM/Revenue Integrity.Certification/Registration/Licensure
- For LVN:Must have current, valid LVN license or temporary LVN
license from the Texas Board of Nursing; or valid Compact LVN
license.
- For RN:Must have current RN license or valid temporary permit
with the Texas Board of Nursing, or valid Compact RN license.Skills
or Special Abilities
- Must be familiar with the rules and regulations of the Texas
Department of Insurance, Joint Commission, Workers' Compensation,
Medicare, and Medicaid Ability to review, analyze, and interpret
managed care contracts, billing guidelines, and state and federal
regulations.
- Must be able to understand and apply Current Procedural
Terminology (CPT) and revenue codes to monitor proper usage and
assure accurate billing procedures.
- Knowledge of treatment protocols, medical and surgical
procedures, and other healthcare practices
- Working knowledge of patient and financial accounting
systems.
- Must be able to work independently and communicate both orally
and in writing with departmental personnel, hospital staff,
vendors, insurance carriers, governmental agencies, and
patients.
- Well-developed research skills.
- Must be able to demonstrate a working knowledge of PC-based
word processing, spreadsheet, and data base software such as Excel
and Word.
- Must have effective oral and written communication skills,
including advanced presentation skills.
- Excellent organizational and project management skills to
permit handling of large workload.
- Background in managed care contract operations and /or billing
compliance highly desired.Responsibilities
- Responsible for promoting adherence to applicable State/Federal
laws and regulations and the program requirements of accreditation
agencies and Federal/State and private health plans in requests for
third party reimbursement and charge audits. Research applicable
laws, regulations and supporting documentation in the analysis of
chargemaster, cost reporting, or other governmental and external
reimbursement requests.
- Reduces risk to Parkland by identifying, documenting, and
reporting potential compliance issues within their specific area of
accountability, such as chargemaster coding reviews and billing
compliance reviews. Audits established processes and procedures to
detect errors or irregularities, assuring compliance with laws,
regulations, and guidelines of Federal/State programs. Develops and
implements new protocols and processes, programs, policies, and
procedures specific to the auditing area that supports the
standards, missions, goals, and objectives of Parkland.
- Coordinates data required for external audits, assuring
timeliness and completion of projects. Documents and computes
impact of possible compliance and billing issues according to
department procedures.
- Identify opportunities and make recommendations for
interdisciplinary and department process improvement such as
analyzing Return to Providers (RTPs) or work queues. Lead
department teams to implement changes, creating work plan and
department procedures required.
- Works with all relevant hospital departments to provide timely
education on improving deficient workflows in order to promote
accurate billing and reimbursement. Prepares and conducts
educational in-services related to accurate billing guidelines for
IV administration and documentation. Works with physicians to
ensure compliance with regulatory billing and documentation
issues.
- Assesses, evaluates, and initiates necessary corrections
pertaining to patient billing charges and documentation to ensure
the integrity of the patient bill, prevent revenue loss, and
provide nursing/billing information while ensuring the hospital's
mission of patient centered and patient valued care. Reconciles
patient charges to documentation and provides rationale for
appropriate charges and documentation to third party insurance
payors, governmental agencies, Parkland's leadership team and to
patients/families.
- Analyzes billing errors and payer denials to identify root
causes for correction and proper billing. This process will include
a thorough review of the medical records and clinical documentation
to verify services provided are accurately reported. Provide
guidance, communication and ongoing education on correct charge
capture and billing protocols to clinical departments as
required.
- Serves as a liaison for internal and external customers by
providing appropriate information and responses to defense audits,
trends for risk management, lack of adherence to policies and
procedures, responding to learning needs of auditors and
patients/families billing concerns. Maintains a positive working
relationship with all internal and external PHHS customers to
assure that optimal and mutual cooperation/customer satisfaction is
achieved.
- Researches, identifies and analyzes charge methodology, design
of documentation, forms, billing and coding processes and
procedures, workflows, trends, etc. for Parkland and implements or
recommends appropriate changes to improve effectiveness,
productivity, efficiency that support the overall goals of
PHHS.
- Will work closely with the CDM team by being a liaison between
all teams responsible for accurate billing and charge capture.
- PFS Only: Responsible for Completion of Emergency Medical
Services Certification, form 3038 by (a)reviewing the patient's
medical records, (b) documenting treatment for an emergency medical
condition and the dates of the treatment, and (c) completing form
H3038 to verify that a nonimmigrant, an undocumented alien, or a
certain legal permanent resident not meeting citizenship
requirements was treated for an emergency medical condition.Job
Accountabilities
- Identifies ways to improve work processes and improve customer
satisfaction. Makes recommendations to supervisor, implements, and
monitors results as appropriate in support of the overall goals of
the department and Parkland.
- Stays abreast of the latest developments, advancements, and
trends in the field by attending seminars/workshops, reading
professional journals, actively participating in professional
organizations, and/or maintaining certification or licensure.
Integrates knowledge gained into current work practices.
- Maintains knowledge of applicable rules, regulations, policies,
laws, and guidelines that impact the area. Develops effective
internal controls designed to promote adherence with applicable
laws, accreditation agency requirements, and federal, state, and
private health plans. Seeks advice and guidance as needed to ensure
proper understanding.#LI-GC1Parkland Health and Hospital System
prohibits discrimination based on age (40 or over), race, color,
religion, sex (including pregnancy), sexual orientation, gender
identity, gender expression, genetic information, disability,
national origin, marital status, political belief, or veteran
status.As part of our commitment to our patients and employees'
wellness, Parkland Health is a tobacco and smoke-free campus.
Keywords: Parkland Health and Hospital System (PHHS), Grand Prairie , Nurse Auditor - Revenue Integrity, Accounting, Auditing , Dallas, Texas
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