Tiffany I. Email & Phone Number

Sugar Land, Tx, Us

Nashville, Tn, Us

Reporting to the Director of Revenue Integrity, process third party hospital audit requests for the Texas and Louisiana Regions.Act as Department liaison to provide reporting to the Nurse Auditor and Coding Auditor to improve charge capture and prevent payer recoupments.Review facility contracts to ensure appropriate compliance to approve hospital audit requests.Liaison between payers, hospitals, and the Shared Service Center (SSC) regarding status of pending, continuing, and finalized payer audits. Responsible for identifying payer trends and report findings to Manager. Interacts and delegate audit projects between responsible SSC departments such as Revenue Integrity for charge audit reviews, HSC for coding or DRG related reviews and Ethics and Compliance and HCA Regulatory Compliance Support (Regs) for government audits.

Houston, Texas, Us

Principle Responsibilities:Review and resolve claim edits for third party payers of Medicare, Medicaid, Blue Cross, Champus, HMO’s, PPO’s, POS’s Workers’ Compensation and Special Contracts. Remain current on charge.capture compliance and payment requirement for all third party payers. Prepare billing for recurrent accounts, Audit treatment and/or encounter dates for Medicare and Medicaid claims. Analyzes accounts for errors, adjustments and credits, issuing corrected entries when necessary. Communicates with other hospital departments and Central Business Office (CBO), Accounting, and Materials Management to clarify coding or charges needed to complete billing process. Maintains working knowledge of ICD 10 and CPT codes for specified services renderedMonitors regulations set in place by compliance programs to maintain conformity. Review treatment and/or encounter dates for Medicare & Medicaid claims to ensure compliance of governmental regulations.Utilizes computer skills of various software packages: Microsoft Office, Excel, Word, Power Point Electronic billing, System on-line reporting programs, Electronic Mail, data base management and systems/mainframe/file server applications. Utilize TDH online Medicaid eligibility systems to verify correct recipient numbers..Prepares daily, weekly and monthly reports , productivity reports and other departmental reports. Mentors and serves as a resource for less experienced staff.Assists with the development of policies and procedures.Adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.Promotes individual professional growth and development by meeting requirements by continuing education through Partners in Learning.Supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor, and resource to less experienced staff.

Houston, Texas, Us

Master'S Degree, Industrial And Organizational Psychology

Bachelor'S Degree, Business Administration And Management, General