Corrections Nurse Salary in Atlanta, GA

Overview The Coding Auditor is a proactive member of an interdisciplinary team of licensed and unlicensed care givers who ensure that patients, families and significant others receive individualized high quality, safe patient care. It is expected that all RN Clinical Nurses - are licensed, knowledgeable and uphold the practice of nursing as outlined by the Georgia Professional Nurse Practice Act and implements the Scope of Practice and Code of Ethics Standards put forth by the American Nurses Association. Schedule:Full Time Shift: Day Shift Level: 6+ years of experience Success Profile Find out what it takes to succeed as a Coding Auditor: Collaborative Time Efficient Organized Critical Thinker Attention to Detail Compassionate Benefits that Reflect Your Contributions Your Pay A compensation program designed for fair and equitable pay. Your Future Secure your future with plans that also include an employer match. Plans and guidance for the future. Your Wellness Traditional healthcare benefits combined with progressive wellness programs to help you be your best self!. Your Joy Special and unique benefits and programs ensuring a balanced life and a workplace culture built on trust. Job Details Facility: VIRTUAL-GAJob Summary: Under direction of the Manager of Coding Assurance/Compliance, reviews chart documentation to ensure coders have appropriate coding and DRG assignment, discharge disposition, admit and discharge dates and reimbursement. Educate staff when errors are identified. Coordinates payment corrections with the assistance of the Billing and Revenue Cycle team: Audit hospital and/or physician medical records and charges to ensure compliance with coding and regulatory standards. Conduct medical record reviews to ensure accurate, ethical documentation, coding, charging and billing practices. Support and provide coding and compliance training to coding staff, physicians, clinical personnel, billing, and/or other hospital staff. Establish effective communication with coding staff, physicians, clinical staff, and/or hospital staff to address documentation, coding, and reimbursement issues. Educate coding staff, physicians, clinical staff, and/or hospital staff on appropriate documentation as required by medical review and governmental agencies. Develop written policies promoting WellStar's commitment to compliance and specific areas of potential fraud and abuse. Use knowledge of coding and compliance guidelines to identify potential billing / reimbursement issues. Participate in special audits as instructed. Work as a team member within Coding Assurance and all other departments. Ability to work remotely and independently with self-driven focus on job completion. Document work processes as required. Perform other duties as assigned. Core Responsibilities and Essential Functions: DRG Validation, RAC and Government Entity Reviews, Appeals, Overpayment Review Functions Investigate overpayment and underpayment issues through DRG reviews, responses to RAC and other governmental audit requests, internally generated audit requests, Epic Work Queue assignments: - Conduct data sampling, auditing, and reporting on all reviews associated with the Annual IP Coding Assurance Audit plan and as otherwise directed to the level of detail required; - Participate in Epic Work Queue assignments as necessary to ensure compliance with governmental and internal regulations; - Research official guidelines to plan scope of focused reviews; - Participate and lead audits with focus on inpatient hospital ICD9-CM, ICD-10-CM / PCS, some CPT4 coding as well as National and Local Coverage Determinations, OIG Work plan, and any other federal/state regulations; - Communicate trends and audit findings with the respective hospital departments and educate as appropriate; - Prepare Findings and Executive Summary reports to distribute to coding and compliance leadership - Prepare and distribute audit findings worksheets to coders; - Engage in cooperative education with the coders when discussing audit findings; - Assist in data warehousing, data reporting, and data integrity tasks of audit data housed in Compliance db's and spreadsheets; - Direct resubmission of claims and help prepare disclosures as necessary. Benchmark comparisons and identification of trends and errors in coded data - Review data analytics; - Identify / track trends and errors to identify overpayments or revenue enhancement opportunities; - Trend and analyze denials, provide feedback and education to all entities ; - Identify, find solution, communicate solution with both external and internal customers as required utilizing Findings and Executive Summary formats; - Distribution and analysis of reports to relevant, affected departments; - Provide and participate in error resolution to correct variances in coding and/or charge practices; - Assist with the implementation of new processes as needed to assure error resolution. Provide education and support - Review CMS regulations and official coding guidance to stay abreast of coding/billing regulatory changes; - Summarize National/Local Coverage Determinations; - Presentations (Develop and present coding/compliance education material); - Provide denial/appeal follow-up; - Provide post review follow-up education with WellStar employees, management and physicians; - Provide education on new releases from Medicare and Medicaid; - Answer compliance/documentation/coding/billing questions via e-mail. Required Minimum Education: Bachelor or Associate-level degree in Health Information Management, Business, or other health care related field preferred (years' experience may be considered in lieu of same). Preferred Required Minimum License(s) and Certification(s): Reg Health Information Admin 1.00 Upon Hire Required Reg Health Information Tech 1.00 Upon Hire Required Cert Coding Spec 1.00 Upon Hire Required Cert Prof Coder - Hospital OP 1.00 Upon Hire Required Additional Licenses and Certifications:Required Minimum Experience: Minimum 5 years inpatient coding experience required with one to two years of hospital-based outpatient services coding experience and one-year inpatient coding audit experience preferred Preferred and A combination of 5 years of comparable experience with hospital coding, billing and reimbursement experience may be substituted for an Associate's degree. Required Required Minimum Skills: Excellent communication, organization, and educational skills. Extensive knowledge of medical terminology, ICD-10-CM and ICD-10-PCS coding (as well as ICD-9-CM), CPT-4 procedural coding (including Level II HCPCS), and all coding and billing guidelines. Hospital billing experience with focus on government payors. Extensive experience with (electronic) medical record chart review and/or extraction, hospital billing. Extensive experience with Medicare, Medicaid, and reimbursement rules and regulations. Experience with management information systems and medical software. Competence in Microsoft Word and Excel software in a Windows environment (Experience with Microsoft Access Is a plus). Share the opportunity Mission, Vision & Values At a time when the healthcare industry is changing rapidly, Wellstar remains committed to exceeding patients' and team members' expectations, while transforming healthcare delivery.Our Mission To enhance the health and well-being of every person we serve.Our Vision Deliver worldclass health care to every person, every time.Our Values We serve with compassion We pursue excellence We honor every voice

Overview The Dir RC Contract Model Build is a proactive member of an interdisciplinary team of licensed and unlicensed care givers who ensure that patients, families and significant others receive individualized high quality, safe patient care. It is expected that all RN Clinical Nurses - are licensed, knowledgeable and uphold the practice of nursing as outlined by the Georgia Professional Nurse Practice Act and implements the Scope of Practice and Code of Ethics Standards put forth by the American Nurses Association. Schedule:Full Time Shift: Shift Level: 6+ years of experience Success Profile Find out what it takes to succeed as a Dir RC Contract Model Build: Collaborative Time Efficient Organized Critical Thinker Attention to Detail Compassionate Benefits that Reflect Your Contributions Your Pay A compensation program designed for fair and equitable pay. Your Future Secure your future with plans that also include an employer match. Plans and guidance for the future. Your Wellness Traditional healthcare benefits combined with progressive wellness programs to help you be your best self!. Your Joy Special and unique benefits and programs ensuring a balanced life and a workplace culture built on trust. Job Details Facility: VIRTUAL-GAJob Summary:The Director Contract Build & Modeling leads Contracts Build and Modeling management team responsible for WellStar Health System (WHS) payor contract builds, modeling, integration, and coordination from request to approval and into production. This position reports to the Executive Director of Revenue Cycle HB A/R Management. This role serves as a revenue cycle expert for WHS migration, integration, and modeling of payor contracts into EPIC contract management platform. He/she advises and directs management staff on higher level decisions or problem resolution to support payment variance contract assessments, quality assurance, build investigation, contract integration, and operational contract interpretation. In addition, he/she has staff management oversight for evaluating system build and reconciliation process to ensure accurate contractual are taken at the time of billing per the analysis, review, and maintenance of WHS's Contract Management applications as outlined in the payor contract language. This Director is responsible for managing various department reports, both ad-hoc and routine, to assist in the identification of payment variance opportunities and other payment irregularities. He/she works with the managed care department with the build and modeling of contract proposals, including what-if scenarios, to demonstrate potential reimbursement, opportunities and/or shortfalls. The Director Contract Build and Modeling ensures WHS patient accounts have an accurate expected reimbursement per the managed care contract language and system build. This leader also works directly with managers in managing vendor partners and act as vendor liaison to reduce revenue leakage from WellStar. This leader is a key member of the team to support financial stewardship within WellStar Health SystemCore Responsibilities and Essential Functions:Responsible for day to day operations of the Contracts Modeling, Integration and Build department.- Manage the daily operations of the Contracts Build and Modeling- Manage the resolution of all contracts build, correction, and modeling in an efficient, timely, and professional manner.- Direct managers responsible for staff that build, model, and integrate contracts into applicable I.T. systems- Manages staff responsible for the process of interpreting and loading complex payer contracts into the WHS Contract Manager production system(s) to enable the system to accurately net down accounts receivable at the time of final bill- Provide high level decision making on complex contracts interpretation, model, and reimbursement issues- Monitor the current standards of productivity and quality expectation for all staff.- Maintain a strong knowledge base of reimbursement procedures of third party and private insurance payers, state and federal regulations, and local regulations relating to insurance and private collections.- Facilitate regular staff meetings to communicate departmental and organizational issues, goals, achievements, and changes.- Select, evaluate, counsel, and discipline as required in a positive manner consistent with medical center Policies- Maintain a system to informally and formally recognize staff for accomplishments.- Demonstrate excellent customer service through oral and written communication.- Meet the current standards of productivity and quality expectations as set forth by management.- Aid in the development of the department's annual operating budget, maintain responsibility for the department operating within the assigned budget- Participate in the testing of assigned software upgrades and programs, and ensure the staff has the appropriate and applicable access to and training on software programs.- Serve as a role model and mentor to co-workers and team members.- Oversee and ensure the completion of all employee paperwork and files, including the accurate and timely completion of payroll, employee evaluations, leaves of absence, Worker's Compensation, and employee education files- Perform other duties and responsibilities as assigned. Operational Systems Management, Maintenance, Support and Development- Responsible for coordinating the maximization of revenue cycle systems and all other computer applications currently used by, or which affect the efficiency of the contracts modeling and build.- Competency evaluation and testing of updates and system implementations /or enhancements- Define and address where delays and backlogs may be occurring in the contracts integration and build- Responsibility for revenue cycle service assigned education, maintenance and support functions through the integrated workgroup and service center. Contract Management, Net Revenue Estimation and Modeling- Responsible for revenue cycle contract management, build, modeling and supporting technologies for Net Revenue evaluation and patient estimation technology platforms.- Ensure accuracy of net revenue contract modeling- Develop key performance indicators, including contract accuracy, turn-around -time for contract creation (Build, Validation, QA and Post Production auditing).Required Minimum Education:Bachelor's Degree in business, healthcare, related field orMaster of Business Administration, or another related field Preferred.Required Minimum License(s) and Certification(s):Additional Licenses and Certifications:Required Minimum Experience:Minimum 5 years experience in Revenue Cycle Management, healthcare contracts build and modeling, healthcare reimbursement experience. RequiredRequired Minimum Skills:Epic knowledgeable, Microsoft Office, excellent communication skills, experience in quality control and training preferred.Experience in project management desired.Demonstrate proficiency in creating monthly Key Performance IndicatorsDemonstrate proficiency in understanding monthly Key Performance IndicatorsCreate and studies revenue reports/Key Performance Indicators and makes recommendations relative to revenue cycle processes for optimizationDemonstrate proficiency in locating and interpreting contract verbiage for timely claims resolutionDemonstrate proficiency in contract management and expected reimbursement technologyDemonstrate knowledge of billing rules and coverage for all Major PayorsIdentify where to locate and review state and federal regulations as they relate to all payersCreate work queue management report for assigned work queuesPost adjustments at time of account reviewCreate/update department policies and proceduresApply appropriate supervisory, management and leadership techniques in an operational settingEvaluate best practices suggestions for possible into the revenue cycleShare the opportunity Mission, Vision & Values At a time when the healthcare industry is changing rapidly, Wellstar remains committed to exceeding patients' and team members' expectations, while transforming healthcare delivery.Our Mission To enhance the health and well-being of every person we serve.Our Vision Deliver worldclass health care to every person, every time.Our Values We serve with compassion We pursue excellence We honor every voice