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Loyola University Health System Charge Capture Review Nurse - 00323141 in Maywood, Illinois

This job was posted by https://illinoisjoblink.illinois.gov : For more information, please see: https://illinoisjoblink.illinois.gov/ada/r/jobs/9051307 nEmployment Type: n

Full time

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Day Shift

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n nDescription: n

POSITION PURPOSE

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Performs analysis of patient clinical and billing data to identify documentation, coding and charging opportunities. Works pre-bill edits and collaborates with intra-departmental team members to identify root cause. Assists with compliance, education, accuracy in charge capture and improvement in the revenue cycle processes as identified through revenue cycle audits and root cause analysis. Works closely with clinical areas to effectively document services performed and understand relationship of documentation, medical necessity, coding and charging for all services provided. Completes assigned reports timely and accurately. May be required to travel between locations within the Region.

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As a mission-driven innovative health organization, we will become the national leader in improving the health of our communities and each person we serve. By demonstrating reverence, commitment to those who are poor, justice, stewardship, and integrity, our organization will continue to provide better health, better care, at lower costs.

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1. Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions

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2. Responsible for working the pre-bill edits within bill drop window, including but not limited to OCE/CCI, claim scrubber edits, and DNFB. Collaborates with intra-departmental team to determine root cause. Meets expected performance metrics and goals.

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3. Assists inter and intra-departmental teams on denial investigations and root cause analysis. Including identifying opportunities for denial prevention through the revenue cycle.

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4. Performs other revenue optimization activities as appropriate and may assist centralized charge control team when necessary.

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5. Maintains an understanding of regulatory and payer changes to ensure correct charging and billing requirements are met.

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6. Communicates and follows-up with designated Utilization Review staff regarding clinical denials. Works with Patient Business Service (PBS) center on requests to or from PBS as needed for payer requests and/or claim adjudication.

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7. Maintains working knowledge of coding and billing regulations for all payors. Keeps current on regulatory updates, local payer policies and procedures to ensure charge accuracy, compliance and optimization.

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8. Other duties as assigned.

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9. Maintains a working knowledge of applicable Federal, State and local laws/regulations; the Trinity Health Integrity and Compliance Program and Code of Conduct as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.

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nTrinity Health's Commitment to Diversity and Inclusion n

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Trinity Health employs about 133,000 colleagues at dozens of hospitals and hundreds of health centers in 22 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

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Trinity Health's dedication to diversity includes a unified workforce (through training and education, recruitment, retention and development), commitment and accountability, communication, community partnerships, and supplier diversity.

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