Revenue Integrity Nurse Data Manager Jefferson Health

Job Details

Job Description

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 42000 employees were 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

Qualifications for this position include:

• Bachelor of Science in Nursing
• Unrestricted PA Registered Nurse license
• Minimum five (5) years of hospital experience in various clinical areas.
• One (1) year medical record auditing utilization review or case management experience strongly preferred.
• 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.

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Primary Location Address

Nationally ranked Jefferson which is principally located in the greater Philadelphia region Lehigh Valley and Northeastern Pennsylvania and southern New Jersey is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65000 people strong dedicated to providing the highest-quality compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrows professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic clinical and applied research. Thomas Jefferson University home of Sidney Kimmel Medical College Jefferson College of Nursing and the Kanbar College of Design Engineering and Commerce dates back to 1824 and today comprises 10 colleges and three schools offering 200 undergraduate and graduate programs to more than 8300 students. Jefferson Health nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age race color religion creed sexual orientation gender gender identity marital status pregnancy national origin ancestry citizenship military status veteran status handicap or disability or any other protected group or status.

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 diemcolleagues adjunct faculty and Jeff Temps) have access to medical (including prescription) insurance.

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