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RCS (Revenue Cycle Solutions) Payment Integrity Coordinator-Full Time Days/72 Hours Per Pay Period

Company: Jobleads
Location: Danville
Posted on: May 3, 2021

Job Description:

RCS (Revenue Cycle Solutions) Payment Integrity Coordinator-Full Time Days/72 Hours Per Pay Period Job Summary : *EXPERIENCE WITH EPIC PREFERRED*The position is responsible to help optimize Revenue Cycle by evaluating for root cause analytics along with audits to help identify opportunities, issues, and process improvement within the Revenue Cycle. This role supports the revenue cycle workflows, charge capture, work queues, and denial review processes.Job DescriptionEssential Responsibilities: Knowledge of; Local Medical Review Policy (LMRP) edits that require the review of clinical documentation against payor specific.Knowledge of; Medical Necessity guidelines such as LCD's (Local Coverage Determination) and NCD's (National Coverage Determination) with the review and coding of conditions and symptoms found in the Medical Record and Physician Query to resolve the edit.Knowledge of; APC (Ambulatory Payment Classifications) edits require the review of NCCI (National Correct Coding Initiative), OCE (Outpatient Code Editor), and MUE (Medically Unlikely Edits) requiring the addition of payment modifiers to resolve the edit.Identifies improper billing and coding including duplication of charges, incorrect procedure billing such as under coding, up-coding, wrong CPT (Current Procedural Terminology) code, or the wrong number of units. Recommends changes to CPT procedures or diagnosis codes per coding guidelines.Claims Edit Monitoring and Resolution- Provides guidance and/or assistance in the correction and prevention of Claim Edits that prevent compliant, timely, and accurate transmittal of claimsIdentifies claims not paid in accordance with the Client's payment policy or Provider's contract language.Validating claim overpayments based on reimbursement methodology, claim coding details, and the audit's edit parameters.Providing guidance and assistance to Auditors and helps identify process and audit concept improvements to ensure the best outcomes.Conducts concurrent and retrospective audits of revenue departments designed to focus on coding, billing, and documentation. Includes audits as directed by the Corporate Compliance Committee, and/or audits related to Office of Inspector General (OIG) Workplan items.Pre-Billing & Retrospective audits (i.e. Correct Coding, Facility E/M, Infusion Coding), Claims Resolution Audits, RAC audits, Modifier Audits, Charge Capture Audits, and other audits as needed or requested, Outpatient or Inpatient. Communicates findings back to the department with re-audit and education as needed based on findings. Performs other Audit duties as assigned.Education: 3-5 years of experience D egree in business, healthcare, or related discipline Licensure or Certifications: Required: RHIT, RHIA, CPC, CCA, or CCS credential, Will allow 24 months to obtain certification.Physical Demands: Requires the physical ability to lift, push, or pull up to 20 pounds Long periods of time for: Sitting Occasional periods of time for: Sitting OSHA Classification: Classification III: For associates in these jobs/positions, the normal work routine involves no exposure to blood, body fluids, tissues, or other potentially infectious materials. Persons who perform these duties are not required as a part of their employment service to perform or assist in emergency medical care or first aid or to be potentially exposed in some way. Have occupational exposure to infectious tuberculosis. Work Shift : 1st Shift (United States of America)Scheduled Weekly Hours : 36 Posted 2 Days Ago Full time R-5868 About Us Welcome! We encourage you to explore this site to learn about the many career opportunities we offer at Hendricks Regional Health. Interested in learning more about us?It all began over 50 years ago when a group of residents wanted to build a hospital in their community, and worked together to bring their dream to life. Over a half-century later, it's still how we do things. This collaborative model of care has helped us become a national trendsetter in patient experience, quality and workplace wellness. It also helps us attract the most innovative, patient-focused physicians, providers and associates available. Hendricks is a place for you to professionally grow and thrive within an independent hospital system. Here you are a part of a strong, rooted community that truly cares, and you'll be surrounded by people who embody The Hendricks Way.

Keywords: Jobleads, Danville , RCS (Revenue Cycle Solutions) Payment Integrity Coordinator-Full Time Days/72 Hours Per Pay Period, Other , Danville, California

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