Position Summary:
Revenue Cycle Audit, 10181
Position Summary
Comments
Audits patient's accounts for clinical document which support charges and medical necessity for the patient's stay. Work with our contractors and outside insurance audit teams to resolve or appeal patients account billing issues.
Core Behaviors
Dependability, Attendance and Punctuality.
a. Unscheduled absences and tardiness must be minimal.
b. Properly uses home clock and badges for clocking (if applicable).
c. Calls 2 hours prior to the start of a shift..
d. Demonstrates respect for others time by arriving on time.
e. Is ready to being work by scheduled start time.
Safety
a. Communication/Teamwork.
b. Safe working practices.
c. Respect for others and patient privacy/dignity.
d. Environment of Care/Employee safety/Emergency management.
e. Incident Reporting.
f. Promotion of safe practices and accident prevention.
g. Hand Hygiene
Compliance and Adherence to Policies, Procedures and Regulations
a. Demonstrates his/her knowledge and willingness to comply with all policies, procedures and regulations.
Organizational Priorities & Position-Specific Responsibilities / Performance Standards
List the major duties/key responsibilities of the position with details on how to achieve that responsibility. Classify each key responsibility under one of the UTMC Organizational Priorities: Service, Efficiency/Effectiveness or Quality/Safety.
Service
Special Projects
a. Completes with the time limit identified by the person requesting the special project.
Serves as a resource to hospital departments regarding patient documentation and patient charging issues.
a. Helps departments resolve documentation errors or issues.
Participates on committees and completes projects as assigned.
a. Completes within time frame established by the committee/supervisor.
Responds to inquires or contacts in a variety of circumstances representing the Charge System Director to internal and external customers.
a. Represents office in an effective and confidential manner.
b. Maintains composure under stressful conditions.
c. Handles confidential and sensitive issues with maturity and professionalism.
d. Handles conflict with diplomacy and presents a professional attitude and appearance.
e. Assists in any way within reason for resolution of complaints, requests or customer concerns.
Efficiency and Effectiveness
Audits organ donor charts and separates organ donor related charges from the pre-donor charges.
a. Completes within five weeks of discharge.
b. Ensures correct charges are billed to Tennessee Donor Services and patient's insurance respectively.
Pre-audits medical record and compares to patient's account for impending outside financial audits.
a. Schedules audits within one year of discharge.
b. Compares charges with medical records and reconciles the financial discrepancies.
c. Defends audit findings in a professional manner with the best possible solution. d. Submits findings to Patient Accounts for correct billings.
Completes pre-billing audits all Medicare Short Stays.
a. Meets as needed with the Director of Case Management to review and resolve any reoccurring issues involving patient status and Physician's orders.
b. Reviews accounts to determine correct status as it relates to the Physician's order, medical record documentation and medical necessity.
c. Serves as a resources to the Case Management and the Bed Placement as necessary to resolve status issues.
d. Provides reports to management of findings.
e. Reviews with our contractor for Medical Necessity and Denial Management when necessary to determine appropriate status.
Coordinates the information between UHS regarding our Medical Necessity denials from the MAC, Medicare HMOs and the RAC.
a. Identifies denials that are appropriate for referral to our contractor for Medical Necessity and Denial Management.
b. Initiates appropriate referral paperwork for each case in coordination with Medical Records for complete submission of all paperwork in a timely manner within our deadline limits.
c. Reviews emails daily from our contractor for Medical Necessity and Denial Management and addresses issues as needed.
d. Reviews all documents received and forwards on to appropriate personnel and departments.
Writes appeals when necessary for Medical Necessity denials from the MAC, Medicare HMOs and the RAC.
a. Completes denial in timely manner required by the entity where the denial came from.
b. Follows-up with any correspondence necessary to complete the appeal process in the time limit given.
Reviews and audits patient's account as it compares to the medical record for Contract Management and Patient Accounts as requested.
a. Completes and notifies requesting party of results within two weeks of receiving completed information.
b. Provides a written response with a detailed explanation.
Quality and Safety
Ensures Medicare billing regulatory compliance.
a. Reviews Medicare billing regulations to ensure regulatory compliance.
b. Reviews as regulations are published.
Protects and retrieves key documents/data.
a. No information is compromised and is available upon request.
b. Documents/files are maintained in an organized manner.
Marginal Responsibilities
Essential Functions
The essential functions are those functions that the team member who holds the position must be able to perform unaided or with the assistance of a reasonable accommodation. The term "essential functions" does not include marginal functions of the position.
The performance of key responsibilities must meet expectations as defined in the performance standards of this position description.
Regular and reliable attendance is an essential function. A team member who does not meet attendance standards outlined in the Personnel Policy, Attendance and Tardiness, is not qualified for this position.
Ability to report for work in a condition to perform job responsibilities and essential functions in a safe and productive manner.
Ability to meet the physical requirements for the position.
Ability to get along with others and consistently engage in and promote positive interactions in the workplace.
The performance of key responsibilities must meet expectations as defined in the performance standards of this position description.
Regular and reliable attendance is an essential function. A team member who does not meet attendance standards outlined in the Personnel Policy, Attendance and Tardiness, is not qualified for this position.
Ability to report for work in a condition to perform job responsibilities and essential functions in a safe and productive manner.
Ability to meet the physical requirements for the position.
Ability to get along with others and consistently engage in and promote positive interactions in the workplace.
Supervisory Responsibilities
# team members reporting directly to this position
0
# team members reporting indirectly to this position
0
Bloodborne Pathogen Category
Category III
Team members who have routine duties/tasks which do not have any risk for exposure to blood and other potentially infective body fluids.
Personal Protective Equipment
None
Education
Degree / Diploma Type
Program
Required/Preferred (and/or)
Bachelors
Experience
Years of Experience
Type of Experience
Required/Preferred (and/or)
1-2
Years of Experience can be related experience and/or training; or equivalent combination of education and experience.
Licensure, Certification, Registration
RN
Registered Nurse in the state of Tennessee
Comments
Language Skills
Skill and Description
Ability to read, analyze, and interpret common scientific and technical journals, financial reports and legal documents. Ability to write reports and correspondence. Ability to respond to common inquiries or complaints. Ability to write speeches and articles for publication.
Mathematical Skills
Skill and Description
Ability to work with mathematical concepts such as probability and statistical inference. Ability to apply concepts, such as fractions, percentages, ratios and proportions to practical situations.
Reasoning Ability
Ability and Description
Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
Skills and Abilities
Skill/Ability and Description
Demonstrates organizational skills
Ability to communicate effectively with staff, patients and visitors
Knowledge of Microsoft Office
Pays close attention to detail.
Equipment
Calculator
Copier
Fax machine
Multi-line telephone
Computer
Scanner
Position Qualification:
RN - Registered Nurse in State of Tennessee
2-3 Years of Experience
Located in Knoxville, Tennessee, The University of Tennessee Medical Center, has a rich history in the East Tennessee community of providing patient-centered care and remaining at the forefront of research, technology and treatments. UT Medical Center attributes its well-respected standing within the community to the exceptional people that dedicate themselves to patient care excellence. The hospital serves as a referral center for Eastern Tennessee, Southeastern Kentucky and Western North Carolina. It is the region’s academic medical center, Magnet® recognized hospital and Level I Trauma Center.