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Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing.
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Must have obtained Medicare billing privileges as a nurse practitioner. Knowledge of Medicare reimbursement and coding for all levels of service - home, office, nursing home, assisted living, etc., Medicaid and other regulatory requirements.
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Demonstrate understanding of reimbursements following Centers for Medicare and Medicaid payment models, e.g. RBRVS Relative Value Units, per diem payments and conversion factors, as well as industry standard managed care terms and conditions.
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Maintains working knowledge base regarding billing, documentation, and reimbursement guidelines/ issues, including but not limited to Medicare, Medicaid, Other Third Party, and contracted payers.
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Expertise in insurance policies and regulations related to medical billing, including Medicare and Medicaid. The individual will need to have expertise in medical billing and collections, as well as a strong understanding of insurance reimbursement processes and regulations related to proton therapy, radiation therapy, and radiology services.
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Assess each account for balance accuracy, payer plan and financial class accuracy, billing accuracy, denials, insurance requests, making any necessary adjustments, documenting appropriately and submits corrections or request for processing in a timely manner.
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Quality Care: One of the only hospitals in Nashville with a Five-Star Rating from the Centers for Medicare & Medicaid Services, Top 5% in the U.S. for spinal surgery, numerous Healthgrades awards for spinal and joint replacement surgery.
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Excellent interpersonal skills that include the ability to effectively communicate with physicians, advanced practice providers and medical office personnel such as Practice and Billing Manager, both verbally and written.
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Reporting to the VP, Compliance/Chief Compliance Officer (CCO), this position supervises and conduct audits to determine organizational integrity of billing for professional (physician) services and/or hospital (technical) services, including: detection and correction of documentation, coding, and billing errors and/or medical necessity of services billed.
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We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Healthcare, hospital systems, hospital, supply chain, workforce management, financial services, technical/systems experience a plus.
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