AdventHealth Maitland seeks to hire Nurse Reviewer Consultant who will embrace our mission to extend the healing ministry of Christ.
Established in 1908, AdventHealth is one of the largest not-for-profit healthcare systems in the country, caring for more than a million patients each year. The Maitland Office Plaza houses our highly skilled teams that support our hospital system including Marketing, Patient Financial Services, Revenue Management, the Credit Union and Human Resources. The Trickel Building, a two-story office structure, creates an atmosphere of health and healing, with a healthy-style cafe and quaint chapel. The main lobby is filled with lush greenery and a light trickle of water, creating a holistic environment.
The Revenue Integrity Department works collaboratively with all Revenue Cycle Department's. The department focus is to ensure the integrity and compliance of the hospital's revenue stream. This responsibility is achieved by performing patient charge audits, denials and appeals management, Local and National Coverage Decision management, and ensuring that the clinical systems and process are in place for charge capture.
*$10,000 Sign-on Bonus available for eligible candidates (see terms below)
The Nurse Reviewer Consultant (NRC) is responsible for accurate and compliant charge capture through the evaluation and appropriate maintenance of all ambulatory and acute clinical operational processes. This role ensures all aspects of the charge master for assigned departments that successfully achieves accurate and compliant with clinical guidelines, regulatory and billing requirements. NRC partners, collaborates and oversees department reviews and charge audits by conducting targeted education based on the charge capture needs for the success of the hospital. Oversees and manages exception-based audits, coordinates and manages regular meetings and other interactions with all clinical areas. Adheres to AdventHealth Corporate Compliance Plan and to rules and regulations of all applicable local, state and federal agencies and accrediting bodies. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.
Ability to work and meet deadlines in a fast-paced, dynamic, project-oriented environment (ever changing)
Ability to relate operational performance in the healthcare environment and to present information to all levels of management
Possesses expert critical thinking and investigational skill set, shows attention to detail, accuracy and ability to operate with a high level of productivity
Excellent communication (verbal and written), presentation and motivational skills
Able to lead, manage and consult with others through difficult situations by building an effective rapport with our clinical teams for charge capture through care delivery
Advanced end user computer skills; MS Office including Word, PowerPoint, Excel and Outlook; Windows operating system and Internet.
Ability to read medical charts or dictation, understand services performed, and correlate those services to charges on the bill (UB-04)
Self-motivated, detail-oriented, and outstanding customer service skills)
Strong clinical acumen and extensive knowledge related to clinical operations including charge capture processes (Preferred)
Extensive understanding of correct coding principles of CPT/HCSPCS and modifier selection as well as CCI edits and Universal Billing Guidelines (Preferred)
Extensive knowledge of Registration, Medical Records Coding, Government, and Managed Care billing rules, coverage, payment, and compliance (Preferred)
In-depth knowledge and ability to navigate hospital's multiple information systems; Examples include working knowledge of Cerner modules and applications (Preferred)
Position may require knowledge into charge capture and revenue protection procedure for legacy systems (e.g. Suncare) (Preferred)
Knowledge of FH Charge master system and the impact changes in the charge master has on the FH Clinical departments and Revenue Cycle (Preferred)
Navigate in DDE (online Medicare billing) when applicable or coordinates with PFS for proper handling (Preferred)
Bachelor's degree in Nursing, AND
Five (5) years' experience in healthcare or related field
Five (5) years clinical experience
Licensure, Certification, or Registration Required:
Current Valid State of Florida or multi state license as a Registered Nurse
Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS) or Certified Professional Coder (CPC).(Preferred)
Demonstrates through behavior AdventHealth's Core Values of Keep Me Safe, Love Me, Make it Easy, and Own it as outlined in the organization's Performance Excellence Program.
Demonstrates, through behavior, AdventHealth's core values of Integrity, Compassion, Balance, Excellence, Stewardship, and Teamwork.
Serves as a consultant/liaison to bridge the gap between clinical areas, finance, and revenue cycle departments. Works pro-actively with administration, finance, revenue cycle, nursing, and ancillary management to assure appropriate clinical business performance.
Collaborates with the charge auditors regarding service line trends and is responsible for following up with charge auditors when issues or questions arise.
Manages and performs charge reviews and proactive audits and improves charge capture by collaborating with clinical departments to ensure compliance, efficiency and effectiveness. This includes:
Identification of gaps in process that contribute to missed, inaccurate, and late charges;
Improvement of department processes and procedures to assure timely and accurate capture of all chargeable activities;
Development of action plan with responsible parties and due dates for identified improvements;
Identifies and establishes controls ensuring compliance and achievement of Clinical and financial goals;
Development of policies and procedures to support and sustain improvements.
Monitors success of performance improvements and escalates issues and risks to the appropriate stakeholders (e.g. Clinical Liaison Manager and Revenue Integrity Director).
Interacts with internal/external audit teams to review charging practices. Analyzing internal/external trends to determine educational, system, and/or process gaps.
Supports clinical information systems ensuring design, maintenance, and utilization complies with charge capture goal.
Coordinates with CDM team regarding regulatory updates in order to educate departments and update clinical ordering screens on an annual basis to ensure compliance with: state regulatory requirements; ICD, CPT, HCPCS, Revenue codes; other medical necessity guidelines; and payer regulations including but not limited to accurate descriptions, coding, additions, and other miscellaneous changes.
Remains current on regulatory and billing guidelines as well as standards of clinical practice for assigned area(s). Maintains a working knowledge of revenue cycle process to aid in the implementation of regulatory standards that assist the health system in cash collection while accurately complying with billing guidelines related to clinical processes.
Utilizes clinical knowledge to provide targeted education with clinicians (Nurses, Nurse Practitioners, Physicians, etc.). Oversees and conducts charge capture process-related education sessions for hospital staff and new department personnel. Reviews and updates existing training documents related to charge capture and clinical documentation.
Works with PFS and Denials Management to identify issues related to denied charges for hospital services and coordinates price file updates with the CDM team.
If you want to be a part of a team that is dedicated to delivering the highest quality in patient care, we invite you to explore the Nurse Reviewer Consultant opportunity with AdventHealth Maitland and apply online today.
Applicable experience required.
Must live 50 or more miles from 601 East Rollins Dr., Orlando, FL to qualify.
AdventHealth Greater Orlando (formerly Florida Hospital) is one of the largest faith-based health care providers in the United States. For 150 years, we have carried on a tradition of providing whole-person care that not only addresses patients' physical ailments, but also supports their emotional and spiritual well-being. We demonstrate the same level of compassion and care for our employees as well, doing all that we can to help them realize their full potential – both personally and professionally.