HCA, Hospital Corporation of America RI Analyst Garden Park in Houston, Texas
GENERAL SUMMARY OF DUTIES - Assist in resolving billing edits that are holding patient claims from billing, by reviewing medical records and other applicable documentation. Maintain the integrity of facility Charge Description Master (CDM) and Revenue Integrity Systems Program. Maintain the integrity of all Ancillary Department systems related to billing and revenue. Position will serve as liaison between Administration, the PAS and Ancillary Department Directors regarding revenue and compliance issues. Position will coordinate all retrospective, concurrent, patient complaint and external billing audits. Provide monthly audit results. Develop and coordinate educational in-services to the Business Office staff and Ancillary staff related to charging and billing issues. Review denial trends for documentation or charging issue opportunities. Review high charge stays/procedures for charging accuracy. Ensures web tool (unbilled) items are addressed properly and timely. Serve as primary contact for all charge-related PAS inquiries and issues.
DUTIES INCLUDE BUT ARE NOT LIMITED TO
Analyzing and resolving patient claims being held by billing edits on the Bill 45, Bill 49, DET,CRT Medical necessity, Correct Coding Initiative, Outpatient Code Editor(OCE), Inpatient Code Editor, Self Administered and other claims requiring clinical expertise's
Interact with ancillary departments to obtain additional information needed to properly bill account based on medical record
Identify charging, coding, or clinical documentation issues and work with ancillary departments to resolve issues and notify appropriate leadership
Reviews all BHL, Mutual, FCSO, PAS Billing Compliance correspondence and adheres to all guidelines
Performs assigned audits by researching documentation, analyzing information, and makes recommendations to improve flow of claim and enters all corrections into the systems
Serves as charge master liaison to include regular reviews of CPT codes, Revenue Codes, review of monthly standard CDM error report and communicating with Ancillary Departments to resolve issues
Member of facility FECC Committee; reports charging issues, etc.
Maintain mandated billing education (i.e. EM Assigner ), attend webcasts and conference calls per HCA Requirements
Perform other related functions as assigned
KNOWLEDGE, SKILLS & ABILITIES
Excellent communication skills both verbal and written
Good interpersonal skills
Able to establish good customer relationships with trust and respect
Able to travel as needed
Computer skills: navigation and edit resolution through various Web based systems, Ability to use email, Excel, Word
LPN or RN preferred
Healthcare experience required, Clinical experience preferred
The employee must live in the Gulfport, MS area.
CERTIFICATE/LICENSE - NA
PHYSICAL DEMANDS/WORKING CONDITIONS - Requires prolonged sitting, some bending, stooping and stretching. Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment. Requires normal range of hearing and eyesight to record, prepare and communicate appropriate reports. Requires lifting papers or boxes up to 25 pounds occasionally. Work is performed in an office environment. Work may be stressful at times. Contact may involve dealing with angry or upset people.
Title: RI Analyst Garden Park
Location: Texas-Houston-RI - Houston
Requisition ID: 25466-125441