RN-Utilization Review

Employer
Ascension
Location
Halethorpe, MD
Posted
Jan 12, 2021
Closes
Jan 14, 2021
Ref
1615520828
Function
Accountant, IT
Industry
Healthcare
Hours
Full Time
Job Description We Are Hiring: Revenue Integrity RN The Revenue Integrity Analyst Registered Nurse is responsible for determining the appropriateness of patient charges, and Charge Description Master (CDM) assigned HCPCS/CPTs, by reviewing the medical record, facility protocol, and other applicable documentation. This review includes the verification of billing data for accuracy and completeness, following regulatory requirements, in order to resolve edits or exceptions detected during system processing of the claim in Patient Accounting or by the Payer. Applies modifiers when appropriate based on this review, and/or makes necessary adjustments to patient account charges and/or balances. Analyzes accounts for specialized billing requirements that require a review of the medical record documentation, regulatory information, and HCA standards. Uses clinical expertise to perform charge reviews and/or works on edits that are deemed appropriate. Serves as a liaison between Patient Accounting, Administration and ancillary department directors regarding charging issues, clinical documentation issues and revenue opportunities. Provides charge review results and develops and coordinates educational in services for staff related to charging/billing issues. Coordinates retrospective, concurrent, patient requested and external billing audits. Reviews denial trends for documentation and charging opportunities. Serves as a primary contact for charge related SSC and facility inquiries and issues. What You Will Do: Provide health care services regarding admission, case management, discharge planning and utilization review. * Review admission and service request within assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria. * Provide case management and/or consultation for complex cases. * Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals. * Assess and coordinate discharge planning needs with healthcare team members. * May prepare statistical analysis and utilization review reports as necessary. * Oversee and coordinate compliance to federally mandated and third party payer utilization management rules and regulations. What You Will Need: Licensure / Certification / Registration: * Registered Nurse credentialed from the Maryland Board of Nursing obtained prior to hire date or job transfer date required. Education: * Diploma from an accredited school/college of nursing required. Why Join Our Team: Serving the greater Baltimore area, Ascension Saint Agnes is recognized as an employer that provides an open, highly collaborative work environment where our workforce reflects the diversity of those we serve. We offer a place of respect and inclusion for all associates as well as a rich learning environment and countless opportunities for career growth and professional development. As an associate, you will find rewarding career opportunities within our 254-bed, full-service teaching hospital, the Saint Agnes Medical Group, Seton Imaging Center and Saint Agnes Foundation. Ascension is a faith-based healthcare organization dedicated to transformation through innovation across the continuum of care. As one of the leading non-profit and Catholic health systems in the US, Ascension is committed to delivering compassionate, personalized care to all. In FY2020, Ascension provided $2.4 billion in care of persons living in poverty and other community benefit programs. Ascension includes more than 160,000 associates and 40,000 aligned providers across a national network of ministries. We offer rewarding careers across more than 2,600 sites of care - including 146 hospitals and more than 50 senior living facilities - in 19 states and the District of Columbia. Equal Employment Opportunity Employer: Ascension Saint Agnes is an Equal Employment Opportunity (EEO) and Affirmative Action employer. Associates and Applicants receive fair and impartial consideration without regard to race, color, religion, national origin, gender identity, sexual orientation, age, physical or mental disability, veteran status, genetic data, or other legally protected status. Pay Non-Discrimination Notice: English_formattedESQA508c.pdf For further information regarding your EEO rights, click on the following link to the "EEO is the Law" poster: EEO is the Law Poster Supplement Please note that Ascension will make an offer of employment only to individuals who have applied for a position using our official application. Be on alert for possible fraudulent offers of employment. Ascension will not solicit money or banking information from applicants. E-Verify Statement: This employer participates in the Electronic Employment Verification Program. Please click the E-Verify link below for more information. E-Verify Right to Work

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