Nurse Data Manager Ex

004186

PRIMARY FUNCTION: This position is responsible for performing clinical audits of detailed patient records with an emphasis on the accuracy of charges posted to meet billing compliance requirements.

ESSENTIAL FUNCTIONS:

• 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

Responsibilities

004186

EDUCATIONAL/TRAINING REQUIREMENTS: • Bachelor of Science in Nursing

CERTIFICATES, LICENSES, AND REGISTRATION: • Unrestricted Registered Nurse license

EXPERIENCE REQUIREMENTS: • Minimum five (5) years of hospital experience in various clinical areas. • One (1) year medical record auditing, utilization review or case management experience, 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 informatio

Closing Statement

About Jefferson

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 42,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's 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 8,300 students. Jefferson Health , nationally ranked as one of the top healthcare systems in the country and the largest provider in the Philadelphia area, serves patients through millions of encounters each year at 17 hospitals and more than 160 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.