Revenue Compliance Analyst (18678)
- Review clinical documentation for accuracy and completeness in accordance with CMS and OIG regulations.
- Audit claims for correct diagnosis and CPT coding, billing accuracy, and timely submission.
- Identify trends in denials or billing errors and recommend corrective actions.
- Collaborate with the Compliance Department on internal audits.
- Support training efforts for clinical and billing staff on documentation standards.
- Complete and review Additional Documentation Requests (ADRs), Appeals, Quality of Care (QOC) and Risk Analysis (RA) from Managed Care and Medicare entities.
- Provide information or feedback/ recommendations.
- Demonstrate professionalism in communication to various departments and outside entities.
- Monitor the effectuations of all resolution / outcomes related to the above pertaining to ADRs, Appeals, QOC and RA.
- Complete audits in various areas according to rules and regulations and offer positive or constructive feedback.
- Manage government probes, including educating on the process, and develop corrective action plans as needed.
- Regulatory research by performing comprehensive research related to payer guidance, facts and circumstances impacting payment outcomes.
- Communicate as a revenue liaison with payers, providers and billing.
- Be able to travel periodically to various facilities and sites
- Able to work on computer and use technology to complete work.
- Nurse or Therapist for minimum of 5 years who has worked in or familiar in the areas of SNF, Home Health, Hospice
- Must have coding certification or certifications that assist with auditing.
Recommended Jobs
Concrete QC Technician
QC Positions Join Hill Country Concrete, a leader in the concrete industry, known for its commitment to quality and innovation. We are seeking dedicated individuals for our Concrete Quality Contr…
Inside Sales & Customer Service Specialist
Job Description Job Description Job Summary This role within the Customer Engagement Center helps with the various service, sales and retention efforts for our Restaurant Services' customers. …
Chula League Treasurer
Chula League Treasurer Who We Are Chula League is a nonprofit formed in 2005 to support the arts, and art education in East Austin managed by a small, grassroots board of directors. We work to ens…
Academic Emergency Medicine | The University of Texas at Tyler School of Medicine in East Texas
Faculty position employed by the University of Texas at Tyler School of Medicine, practicing in UT Health East Texas facilities. University of Texas Health North Campus Tyler is searching for a d…
Locum Medical Oncologist
Palm Health Resources is currently hiring for a locum medical oncologist to provide ongoing coverage in Eastern Texas starting in September. This is a 100% outpatient position with No Call, No Admiss…
Hotel Maintenance Supervisor - Full Time - $25.50+ per hour based on experience - Private Hotel & Training Center!
About Us: At Pyramid Global Hospitality (also known as Benchmark Hospitality), people come first. As a company that values its employees, Pyramid Global Hospitality is dedicated to creating a support…
Project Management Manager - Remote
Job Description The Portfolio Group, under the Workplace Experience Group umbrella, delivers seamless experiences from the breakroom to the boardroom, providing a signature suite of services for e…
Surgical Services - Sterile Processing Tech (SPT)
Sterile Processing Department Monday to Friday 2330 to 0700 with 1 weekend call/month Can work with Censitrac instrument tracking tool, steris washers and sterilizers, VPRO max, medivators
Adventure Awaits: RN Opportunities in Vibrant Longview!
Registered Nurse - Progressive Care - Travel - (PCU RN) Join a dedicated team as a Registered Nurse in vibrant Longview, TX, a hub of festivals and outdoor adventures. Work in a dynamic 170-bed Level…
Medical Staff Credentialing Coordinator
Overview We are seeking a Credentialing Coordinator , also referred to as a Medical Staff Coordinator or Medical Staff Office Coordinator. A Credentialing Coordinator in our ensures that health…