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Auditor-Revenue Integrity Charge - Remote Available Days - HS Revenue Process & Analysis Corporate

Job ID: 6850
Job Category: Finance and Accounting
Job Type: Non Clinical
Work Type: Full Time
Work Schedule: Days
Facility: BMHCC Corporate Office
Location: Memphis, TN

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Summary

This position will focus on evaluating compliance with BMHCC policies as well as compliance with applicable Medicare, Medicaid and other third party guidelines in effect as of the applicable date of service, including identification of lost revenue opportunities and overpayments that need to be refunded due to documentation, coding or billing issues.The Hospital Compliance Revenue Integrity Charge Auditor will lead defense audits, perform hospital, payer and physician billing compliance auditing and monitoring activities for Baptist Memorial Health Care Corporation (BMHCC). Accountable for assigned and delegated reports and completion from senior leadership and/or department director. Assist the Revenue Integrity Director to ensure consistency in delivering services efficiently, timely, and great quality to all hospitals and BMH entities. Assist the Revenue Integrity Director to ensure the integrity of the processes and that federal and state compliance is met in regards to charging and billing practices for healthcare services. Strives to reach and maintain department goals at the highest standard in all areas of responsibility, task, and patient satisfaction as set by Administration and Corporate expectation. Takes initiatives to improve processes, strives for positive customer outcomes. Leads by example.Responsible for all shifts, 7 days/week, 24 hours/day.

Responsibilities

  • Assist the Revenue Integrity Team with reviewing patient records for appropriate coding and charging decisions for the claim to prevent a denial with the insurance carrier.
  • Provides leadership through facilitating visions/values through personal example and interaction with staff. Communicate policies and goals, which will result in enhanced employee skills, management, and leadership.
  • This position is responsible for driving revenue integrity compliance program "operational excellenceâ€� (i.e., standardization, scalability, effectiveness and efficiency) related to charging practices to meet an evolving landscape of regulatory compliance requirements.
  • This position will be responsible for implementing charging edits and leading system applications associated with charge assurance systems.
  • This position will perform audits with a focus on evaluating compliance with BMHCC policies as well as compliance with applicable Medicare, Medicaid and other third party guidelines.
  • Demonstrates Service First characteristics to all. Sets example for department and other hospital personnel. Identifies opportunities for improvement resulting in enhanced service and customer satisfaction.
  • Performs related accountabilities/responsibilities as required or directed.

Requirements, Preferences and Experience

Education

Preferred: Masters in Healthcare Administration, Business Administration, and/or Nursing.

Minimum: Bachelor's degree in Healthcare Administration, Business/Management, Information Systems, Nursing, or other Healthcare discipline is Required.

Experience

Preferred: A minimum of 15 plus years experience in a health care environment to include demonstrated management and leadership in hospital billing compliance/auditing.

Minimum: A minimum of 10 years experience in a health care environment to include demonstrated management and leadership in hospital billing compliance/auditing.

Licensure, Registration, Certification

Preferred: Registered Nurse, Certification in Healthcare Compliance (CHC). Additional specialty coding certifications (e.g., Iopaedic Surgery (COSC), Emergency Department (CEDC), etc.) desired.

Minimum: Certified Coding Specialist-Hospital-Based (CCS-H) or Cert. Outpatient Coder (COC)nterventional Radiology and Cardiovascular (CIRCC), Cardiovascular and Thoracic Surgery (CCVTC), Orth

Special Skills

Preferred: l

Minimum: Knowledge and experience with hospital related heath care laws and regulations (e.g., False Claim Act, Anti-Kickback Statute, Stark Law, etc.), and hospital inpatient and outpatient coding and billing compliance. Familiarity with federal and state charging and compliance regulations. Familiarity with operational, financial, and information technology security procedures and regulations. Strong performance in payer defense audits and internal risk assessments audit

About Baptist Memorial Health Care

At Baptist, we owe our success to our colleagues, who have both technical expertise and a compassionate attitude. Every day they carry out Christ's three-fold ministry-healing, preaching and teaching. And, we reward their efforts with compensation and benefits packages that are highly competitive in the Mid-South health care community. For two consecutive years, Baptist has won a Best in Benefits award for offering the best benefit plans compared with their peer groups. Winners are chosen based on plan designs, premiums and the results of a Benefits Benchmarking Survey.

At Baptist, We Offer:
  • Competitive salaries
  • Paid vacation/time off
  • Continuing education opportunities
  • Generous retirement plan
  • Health insurance, including dental and vision
  • Sick leave
  • Service awards
  • Free parking
  • Short-term disability
  • Life insurance
  • Health care and dependent care spending accounts
  • Education assistance/continuing education
  • Employee referral program

Job Summary:
Position: 13218 - Auditor-Revenue Integrity Charge
Facility: BMHCC Corporate Office
Department: HS Revenue Process & Analysis Corporate
Category: Finance and Accounting
Type: Non Clinical
Work Type: Full Time
Work Schedule: Days
Location: US:TN:Memphis
Located in the Memphis metro area

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