Healthcare Jobs in Tuscaloosa, AL (Now Hiring) — 241 open — Page 11

Overview

The Revenue Integrity Coordinator (RIC) is responsible for the identification, implementing and monitoring results for all revenue integrity related activities in accordance with department policy. This includes working with team members to identify causes of denied, rejected, or underpaid claims.  The RIC will take action in correction errors and by making appropriate referrals that will result in the protection of potentially lost revenue.  The  RIC will track and report causes of denied, rejected, or underpaid claims and work front end/concurrent/and retrospective case for authorizations. The RIC will lead the team to retrieve, enter, and/or disseminate date to receive authorization on concurrent and retrospective cases.  The work of the RIC will include providing information, through team reporting, to the appropriate individuals to facilitate performance improvement throughout the DCH System. The RIC role will provide oversight of the team focus on preventing and reversing denials.

Responsibilities

 

Develops detailed knowledge of and drives the focus and goals of  Utilization Review (UR)

Retrieves and disseminates clinical data to third-party payers for authorization/certification of hospital level of care for front end/concurrent and retrospective certifications

Provides orientation, direction, and ongoing mentoring/coaching of the  Care Coordination Clerk (MOONs; IMMs; Condition Code 44’s, Kepro Requests for Medicare appeals, entering moms & babes on JIVA & MIDAS, etc)

Refers adverse outcomes from third-party payers to appropriate  member of the UR team

Identifies opportunities for improvement related to denial management and report outcomes to the  URM at least monthly

Works with the DCH financial counselors  and registration to identify correct/accurate payer source

Documents data in third-payer payer systems allowable within the revenue integrity skillset

Documents certification data in Care Management and  Business Office systems

Maintains accuracy of inpatient and outpatient working spreadsheet to include posting of payment, payment date, payor, and action performed

Works within established processes of  UR to identify denied/rejected/underpaid claims

Performs interventions, appeals, and appropriate referrals to protect and collect potentially lost revenue by  following up on inpatient and outpatient interventions and appeals to include calling insurance companies,  physician’s offices, patients, and related DCH departments

Maintains spreadsheet of criteria utilized by payers to deny claims or oversees this document

Provides oversight for authorizations and denials  and forwards to  Medical Records

Assists UR Manager in developing strategies for overturning appeals and reversing denied claims

Applies critical thinking skills and knowledge to each claim to prioritize and perform interventions to maximize revenue protection  within timely filing

Ensures that communications are maintained regarding revenue integrity with all involved departments

Supports the team through follow-up on inpatient and outpatient appeals and interventions

Utilizes Compliance 360, MIDAS,  and eFR for reports and information related to denials

Attends departmental meetings and assists the URM in educating the  UR team on denial prevention

Participates in annual departmental project and assists in leading  the team in UR denial prevention

Assists URM to arrange team meetings and may be responsible for minutes as necessary/requested

Maintains performance, patient and employee satisfaction and financial standards

Adheres to DCH Behavioral Standards including creating positive relationships with patients/ families, and colleagues  

Provides level of care reports to Medical Records

Provides back-up clerical support as needed

 

DCH Standards:

• Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance evaluation.
• Performs compliance requirements as outlined in the Employee Handbook.
• Must adhere to the DCH Behavioral Standards including creating positive relationships with patients/families, coworkers, colleagues and with self.
• Performs essential job functions in a manner that ensures the safety of patients, visitors and employees.
• Identifies and reduces unsafe practices that may result in harm to patients, visitors and employees.
• Recognizes and takes appropriate action to reduce risks and hazards to promote safety for patients, visitors and employees.
• Requires use of electronic mail, time and attendance software, learning management software and intranet.
• Must adhere to all DCH Health System policies and procedures.
• All other duties as assigned.

Qualifications

MINIMUM KNOWLEDGE, SKILLS, EXPERIENCE REQUIRED

 

• Current approved Alabama Board of Nursing RN license or multi-state license required or ability to obtain prior to start.
• Current American Heart Association (AHA) or American Red Cross Basic Life Support (BLS) Provider training required.
• BSN preferred, minimum Associates required
• Must be able to read, write legibly, speak, and comprehend English.

 

Required within 6 months of start date:  American Heart Association or American Red Cross accepted

 

Cardiac/Critical Care:

• ACLS

Emergency Department-both campuses:

• ACLS
• Pediatric Advanced Life Support (PALS)

Emergency Department – Regional Campus only:

• Trauma Nursing Core Course (TNCC)

Perioperative:

• ACLS
• PACU –PALS; ACLS

Women’s/Children:

• NICU –Neonatal Resuscitation (NRP)
• Labor & Delivery –ACLS, NRP, and Intermediate Fetal Monitoring
• Mother Baby Unit – NRP
• Pediatrics – PALS

Clinical Support:

• Cardiac Monitoring Unit –ACLS

Dialysis:

• ACLS

 

International RNs:

• Current approved Alabama Board of Nursing RN license or multi-state license required or ability to obtain prior to start.
• Current American Heart Association (AHA) or American Red Cross Basic Life Support (BLS) Provider training required or obtain within 30 days of start date.
• BSN preferred, minimum Associates required
• Must be able to read, write legibly, speak, and comprehend English.

 

Working Conditions

 

WORK CONTEXT

• Demonstrate leadership skills
• Requires decision making that will affect others
• Responsible to achieve outcomes
• Must be able to communicate clearly and accurately
• Ability to delegate to team members and students
• Must be able to receive delegation
• Address conflict and stressful situation
• Communicate with different personalities and engage in face to face discussion
• Dealing with unpleasant or verbally/physically aggressive personalities
• Must be able to use electronic mail, telephone and texting
• Must be able to work in groups
• Must be able to perform structured and unstructured work
• Must be able to meet time pressure and time lines
• Includes possible exposure to human body fluids, disease, infection, lab chemicals and hazardous materials and/or cleaning solutions
• Requires wearing of common protective and safety equipment such as gloves, safety glasses, mask, gowns, etc.
• Schedules vary; every other weekend required. Weekends include Saturday & Sunday

PHYSICAL FACTORS

• Medium work. Exerting up to 50 pounds of force occasionally, and/or up to 30 pounds of force frequently, and/or up to 10 pounds of force constantly to move objects.Must be able to tolerate prolonged periods of standing and walking
• Must be able to reach reasonable distances in any direction
• Must be able to stand, walk, kneel, bend, sit and stoop
• Must be able to run in an emergency
• Must have the ability to exert maximum muscle force to lift, push, pull and carry objects
• Must be able to move fingers in a coordinated manner and must be ablet o feel and perceive temperature, texture, shape and size with fingertips
• Must be able to perform the duties with or without reasonable accommodation
• Must possess stamina to work prolonged shifts
• Hearing and vision must be normal or corrected to within normal range.
• Physical presence onsite is essential.

 

KEY WORD SEARCH

 

Staff Nurse, Registered Nurse, Nurse, RN