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Role Description

Join the mission of Improving Lives as a Revenue Integrity Nurse Data Manager at Jefferson Health. This position is a 100% Remote – FT Days Position – Monday thru Friday!

• 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

• 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.

Benefits

• 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.
• 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.