Revenue Integrity Nurse Data Manager - Jefferson Health

Jefferson Health Plans • Philadelphia, PA

4d • Remote

About The Position

Revenue Integrity Nurse Data Manager - Jefferson Health Join the mission of Improving Lives as a Revenue Integrity Nurse Data Manager at Jefferson Health. With more than 42,000 employees, we’re the second largest employer in Philadelphia and the largest health system in the Philadelphia region. And our work to improve lives is never done. This position is a 100% Remote – FT Days Position – Monday thru Friday! Nurse Data Managers are responsible for the following: Performing clinical audits of detailed patient records with an emphasis on the accuracy of charges posted to meet billing compliance requirements. Interacts with co-workers, visitors and other staff consistent with the values of Jefferson. Completes chart-to-bill audits as requested by customers and/or management, or pursuant to 3rd party payer requests and audit activity. Improves the performance of charge capture process to include assisting in the development of best practices, coordinating error resolution and establishing prevention measures. Performs external defensive audits and reports findings to management. Provides clinical staff billing documentation and billing guidance. Reviews medical records to determine whether the documentation substantiates utilization and billing of patient accounts. Resolves patient account edits in Electronic Health Record system Provide clinical support through interpretation to the patient accounting and customer service as it relates to medical terminology and hospital charging policies as needed. Assist patients (directed from customer service) in understanding hospital specific charging mechanisms and facilitates resolution of all charging questions or disputes as needed

Requirements

• Bachelor of Science in Nursing
• Unrestricted PA Registered Nurse license
• Minimum five (5) years of hospital experience in various clinical areas.
• Familiarity with hospital coding and billing processes.
• Knowledge of applicable healthcare and compliance laws and regulations.
• Understanding of Medicare and Medicaid reimbursement and fraud and abuse laws.
• Superior interpersonal and communication skills.
• Strong computer skills.
• Strong organizational skills to support multiple priorities.
• Good judgment and strong logic abilities.
• Demonstrated ability to maintain confidentiality of patient records and other sensitive information.
• Knowledge of Microsoft Word and Excel.

Nice To Haves

• One (1) year medical record auditing, utilization review or case management experience, strongly preferred.

Responsibilities

• Performing clinical audits of detailed patient records with an emphasis on the accuracy of charges posted to meet billing compliance requirements.
• Interacts with co-workers, visitors and other staff consistent with the values of Jefferson.
• Completes chart-to-bill audits as requested by customers and/or management, or pursuant to 3rd party payer requests and audit activity.
• Improves the performance of charge capture process to include assisting in the development of best practices, coordinating error resolution and establishing prevention measures.
• Performs external defensive audits and reports findings to management.
• Provides clinical staff billing documentation and billing guidance.
• Reviews medical records to determine whether the documentation substantiates utilization and billing of patient accounts.
• Resolves patient account edits in Electronic Health Record system
• Provide clinical support through interpretation to the patient accounting and customer service as it relates to medical terminology and hospital charging policies as needed.
• Assist patients (directed from customer service) in understanding hospital specific charging mechanisms and facilitates resolution of all charging questions or disputes as needed

Benefits

• Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts.
• Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service.
• All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level