Revenue Integrity staff to manage Charge Master, Clinical Billing Edits and Clinical Chart Audit process per SOX internal Audit requires and per Lifepoint Policy and Parallon processes.
Directs and Manages timely Charge Master (CDM) maintenance for facility. Prepares all CDM related paperwork per DLP Policy utilizing CDM templates for each CDM update.
Works in conjunction with clinical directors and facility CFO on CDM needs. Includes analyzing charges for reimbursement, medical necessity, HCPCS/CPT codes and clinical coverage. Submit CDM reimbursement and Prepares Lifepoint CDM request for CDM adds/deletions/changes and submits to CFO for approval then to Lifepoint HSC Revenue Integrity dept. Tracks CDM requests and maintains back up for mandated SOX Audit requirements.
Performs monthly Lifepoint SOX Internal Audits which requires working knowledge of the LifePoint CAT system. Performs audit to match charges to documentation as well as calculates over and undercharges and submit corrections for rebill per CAT audit process.
Ability to work with Lifepoint deadlines to audit, record results and submit in Lifepoint CAT system. Also must work with clinical department to identify audit discrepancies and report trends and assist with seeking issue resolution. Utilizes CAT system as well as CERNER Electronic Medical Records.
Must be able to read and interpret medical documentation that supports orders and justification for charges. Requires clinical knowledge and medical terminology.
Performs Revenue Integrity duties to resolve clinical billing edits returned from Parallon via request Software. Works hospital clinical staff and coders for edit resolution.
Requires extensive clinical knowledge of billing processes including but not limited to HCPCS/CPT codes, MUE (Medical Unlikely Edits and NCCI (National Correct Coding Initiative) Edit. Also must have knowledge to read and interpret CMS/Medicare Local and National Coverage Determinations (LCD/NCD) for medical necessity. Job Set requires knowledge of billing regulations, medical necessity requirements, medical terminology, anatomy and Physiology terms.
Must be proficient in Excel and use of email. Must have ability to interpret Cerner clinical documentation system to match to charges on patient accounts. Must be proficient or willing to train in various Parallon software programs including eRequest, Artiva, Host and eTran.
Must possess critical thinking skills, work productively and independently to satisfy goals and deadlines. Must have excellent written and verbal communication skills.
Associate's degree is required
Bachelor's degree is preferred
Prefer RN or LPN license in North Carolina or must have experience in Billing/Coding and/or other Clinical Experience.
Must have medical terminology knowledge.
May consider to allow staff to work remotely.
Must be able to travel to facility for on-site training and meetings.
Revenue Integrity Certification is preferred.