Credentialing Billing Integrity Analyst

HCA Healthcare; Brentwood (TN); On-site; USD 65,000 - 95,000; Full time

Benefits offered by this job

Medical & prescription

Dental & Vision

Wellbeing support

401(k) match

Education support

Fertility benefits

Job summary

HCA Healthcare, through Parallon, seeks a Credentialing Billing Integrity Analyst to determine the appropriateness of patient charges and HCPCS/CPT coding by reviewing medical records and facility protocols. You will serve as a primary contact for charge-related inquiries and ensure regulatory compliance in billing processes.

The role requires an associate degree or higher with healthcare experience; RHIT/CCS/CPC credentials are preferred.

Qualifications

• Associate degree or higher; healthcare license/certification required.
• Minimum 1 year directly related healthcare experience or coding experience.
• Knowledge of CPT/HCPCS codes or charging validation reviews preferred.
• Healthcare certification/licensure such as RHIT, CCS, CCP, CPC or AHIMA credential, can be accepted in lieu of degree with work experience.

Responsibilities

• Analyze and resolve billing edits requiring HCPCS/CPT coding based on chargemaster expertise and ensure timely claim processing.
• Identify charging, chargemaster coding, or clinical documentation issues and coordinate resolution with leadership and ancillary departments.
• Serve as chargemaster liaison to educate clinical departments on CPT codes and communicating with Ancillary Departments.
• Review CMS transmittals and LCDs; assess impact to Billing Integrity procedures and implement changes as needed.
• Maintain billing education and participate in webcasts and conference calls as required.

Skills

Billing accuracy

Regulatory compliance knowledge

Attention to detail

Education

Associate degree or higher (healthcare)

Tools

CPT/HCPCS coding knowledge

Chargemaster knowledge

Job description

Are you passionate about the patient experience? At HCA Healthcare, we are committed to caring for patients with purpose and integrity. We care like family! Jump-start your career as a(an) Credentialing Billing Integrity Analyst today with Parallon.

Job Summary and Qualifications

The Billing Integrity Analyst (Credentialed) is responsible for determining the appropriateness of patient charges, and Charge Description Master (CDM) assigned HCPCS/CPTs, by reviewing the medical record, facility protocol, and other applicable documentation. This review includes the verification of billing data for accuracy and completeness, following regulatory requirements, to resolve edits or exceptions detected during system processing of the claim in Patient Accounting, Relay Health or the payer. Serves as a primary contact for charge related SSC and facility inquiries and issues.

What you will do in this role

• Analyze and resolve specific billing edits that require HCPCS/CPT coding based on the chargemaster expertise and that are delaying claims from processing in the Patient Accounting and/or Relay Health systems. This includes the verification (and/or correction) of billing data for accuracy and completeness, by following regulatory requirements, and reviewing the medical record, facility protocol, and other applicable documentation. This also includes the application of modifiers and condition codes, as appropriate.
• Identify charging, chargemaster coding, or clinical documentation issues and work with appropriate leadership and ancillary departments to resolve issues that are identified while working on edits.
• Serve as charge master liaison to facilitate clinical department education on appropriate charging of CPT codes, Revenue Codes, and communicating with Ancillary Departments to resolve issues. Coordinates updates (activate, inactivate, modification) with Ancillary Departments as necessary
• Review Regulatory and Compliance Communications, applicable CMS transmittals, and Local Coverage Decisions (LCD). Assess impact to Billing Integrity procedures and implement changes as needed.
• Maintain billing education, attend webcasts and conference calls as required.

What qualifications you will need

• Associate degree or above; or healthcare license/certification required.
• Minimum 1 year directly related Healthcare experience or coding experience required.
• Knowledge of CPT/HCPCS codes or experience in charging or performing charging validation reviews preferred. Certificate/License:
• Healthcare certification/licensure such as RHIT, CCS, CCP, CPC or other recognized AHIMA certified coding credential, LPN, LVN, RT, PT, etc., can be accepted lieu of degree with work experience

Benefits

Parallon, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services
• Wellbeing support, including free counseling and referral services
• Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence
• Savings and retirement resources , including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling
• Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing
• Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts

Learn more about Employee Benefits (https://careers.hcahealthcare.com/pages/employee-benefits-and-rewards)

Note: Eligibility for benefits may vary by location.

Parallon provides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers and their communities.

HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

“The great hospitals will always put the patient and the patient’s family first, and the really great institutions will provide care with warmth, compassion, and dignity for the individual.”- Dr. Thomas Frist, Sr.

HCA Healthcare Co-Founder

We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.