Medical Necessity Compliance Coordinator - HCA : Job Details

DescriptionIntroductionDo you want to join an organization that invests in you as a Medical Necessity Compliance Coordinator? 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.BenefitsParallon, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:* Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.* Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.* Free counseling services and resources for emotional, physical and financial wellbeing* 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)* Employee Stock Purchase Plan with 10% off HCA Healthcare stock* Family support through fertility and family building benefits with Progyny and adoption assistance.* Referral services for child, elder and pet care, home and auto repair, event planning and more* Consumer discounts through Abenity and Consumer Discounts* Retirement readiness, rollover assistance services and preferred banking partnerships* Education assistance (tuition, student loan, certification support, dependent scholarships)* Colleague recognition program* Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)* Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.Learn more about Employee BenefitsNote: Eligibility for benefits may vary by location.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 Medical Necessity Compliance Coordinator like you to be a part of our team.Job Summary and QualificationsThe Medical Necessity Coordinator is responsible for coordinating reviews and compliance initiatives and maintain documentation of all NCDs/LCDs/LCAs which have been identified for each facility/division. The NCD/LCD Coordinator identifies any special requirements such as mandatory worksheets, medical necessity requirements, documentation requirements, qualifications, licensures, or certification of individuals. They must also ensure the facility and/or physician performing the services have met the special certification, accreditation requirements. This position is also responsible for trending issues related to Medical Necessity write offs as well as development and implementation of process improvement in these areas where write off volumes are high.What you will do in this role:* Coordinate NCD/LCD/LCA review process at the Division level* Determine whether new/revised NCDs/LCDs/LCAs apply to hospital's services, procedures and devices* Ensure references including applicable NCDs, LCDs, LCAs, HCA Healthcare Policies, mandated enterprise tools, documentation toolkits, worksheets, and resources are available to hospital departments, physicians and Non-Physician Practitioners* Monitor for NCD/LCD/LCA updates via Regs NCD/LCD/LCA Communications, Regs Coverage Corner issues and CMS and MAC Listservs to update appropriate ancillary departments and physicians* Coordinate and assist with continuing education of hospital departments and medical staff relative to NCDs/LCDs/LCAs* Report key NCD/LCD/LCA activities to FECC such as: high priority NCDs/LCDs/LCAs, new/revised NCD/LCD/LCA reviews, action plans, successes/challenges related to implementation, volume of denials related to high priority NCDs/LCDs/LCAs, any issues that require escalation for resolution* Monitor compliance with HCA Healthcare Policy REGS.GEN.011, Medicare - National and Local Coverage Determinations* Government/Non-government medical necessity compliance reviews as well as trending and development of improvement plans based on findings* Perform routine trends of write offs and execute action plans to ensure medical necessity is met prior to procedures being performed by doing upfront reviews of NCD/LCD that have high volume/dollar write offs* Development and implementation of education/improvement plans for assigned service lines* Ensures clinical documentation requirements are met to support correct claims as well as identifies potential areas for automation* Acts as general compliance SME for facility leaders* Evaluates new service lines medical necessity requirements* Provides general/focus education for facility leaders on (but not limited to) compliance, medical necessity, charge practices, coding requirement etc.* Tracks all education and projects in designated tracking toolWhat qualifications you will need:* Associates Degree Required but equivalent work experience may substitute education requirements.* Minimum 3 years of hospital coding experience preferred* Minimum 5 years healthcare experience (hospital operations, clinical operations, etc.)* Minimum 1 year NCD/LCD experience preferred* Healthcare certification/licensure such as RHIT, CCS, CCP,CPC or other recognized AHIMA certified coding credential, LPN, LVN, RT, PT, etc., required (must obtain certification within 1 year of state date)Parallon provides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll, and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers, and their communities.HCA Healthcare has been recognized as one of the Worlds Most Ethical Companies by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated 3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses. Good people beget good people. - Dr. Thomas Frist, Sr.HCA Healthcare Co-FounderWe are a family 270,000 dedicated professionals! Our Talent Acquisition team is reviewing applications for our Medical Necessity Compliance Coordinator opening. Qualified candidates will be contacted for interviews. Submit your resume today to join our community of caring!We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.