IPAT Clinical Analyst RN or LPN

With 340 beds, 1,440 staff members, and 1,200 physicians, MountainView Hospital is a state-of-the-art, full-service medical facility located in the heart of Northwest Las Vegas, one of the fastest growing areas in the valley. MountainView features nationally recognized programs including a top cardiovascular and thoracic center, the renowned Las Vegas Institute for Robotic Surgery, an Accredited Chest Pain Center and Certified Stroke Center. Other areas of excellence include emergency care, urology, wound care and gynecological services, orthopedics, vascular care and an inpatient rehabilitation unit. Through MountainView’s Graduate Medical Education program MountainView trains the next generation of physicians and surgeons. MountainView Hospital is recognized for high patient satisfaction and for providing quality and compassionate care to our community since 1996.

Hourly Wage Estimate: $25.99 - $38.98 / hour Learn more about the benefits offered for this job. The estimate displayed represents the typical wage range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in this role. The typical candidate is hired below midpoint of the range. Introduction This Work from Home position requires that you live and will perform the duties of the position; within 60 miles of an HCA Healthcare Hospital (Our hospitals are located in the following states: FL, GA, ID, KS, KY, MO, NV, NH, NC, SC, TN, TX, UT, VA). Do you want to join an organization that invests in you as an IPAT Clinical Analyst (RN or LPN)? At Parallon, you come first. HCA Healthcare has committed up to $300 million in programs to support our incredible team members over the course of three years. You contribute to our success. Every role has an impact on our patients’ lives and you have the opportunity to make a difference. We are looking for a dedicated IPAT Clinical Analyst (RN or LPN) like you to be a part of our team. Job Summary and Qualifications The IPAT Clinical Analyst (RN or LPN) will review post discharge, prebill accounts that do not have authorization on file, ALOS versus days authorized variances, and/or other account discrepancies identified that will result in the account being denied by the payor that require clinical expertise. Communicates with third party payors to resolve discrepancies prior to billing. Accurately and concisely documents all communications and action taken on the account in accordance with policies and procedures. Escalate medical review request and /or denial activities to management as needed.

Work post discharge, prebill accounts efficiently and effectively daily to resolve accounts with “no auth numbers, ALOS vs. authorized days or other discrepancies. Evaluates clinical documentation on multiple patient accounts and escalates issues through the established channels. Perform accurate and timely documentation of all review activities based on policy and procedure. Demonstrates a working knowledge of managed care agreements based on available resources which may include and not be limited to payer UM Manual, policy and procedure, facility contract information. Escalates variations timely. Work assigned accounts in eRequest to resolve outstanding issues. Report insurance denial trends identified during daily operational assignments. Contact facilities, physicians’ offices and/or insurance companies to resolve denials/appeals if needed. Demonstrates knowledge of regulatory requirements, Ethics and Compliance policies, and quality initiatives; monitors self-compliance and implements process changes to ensure compliance to such regulations and quality initiatives. Assess CPT code(s) for outpatient accounts that require authorization when accounts have not been coded.