What are the responsibilities and job description for the REIMBURSEMENT SPECIALIST position at Aultman Health Foundation?
Position Summary:
This position is in our Clinical Charge Capture Team within the Revenue Management Department. This team is responsible for accurate and timely manual charge posting for our 3 hospitals and various outpatient areas.
Charge capture includes the review of all outpatient observation and inpatient encounters for accurate admission status. Also, drug administration/infusion charges according to coding guidelines, review and update observation hours and carve-outs according to current CMS guidelines, ER levels and procedures on admitted ER visits (to either obv or inpatient), several HOPD offices, and other ancillary departments. The team is responsible for obtaining optimal revenue while maintaining compliance with all regulations. The position requires knowledge of; charge capture and flow processes, charging information systems, coding and reimbursement regulations.
May also be expected to assist in performing other administrative tasks assigned as well as assisting other areas of the revenue cycle division or clinical services division as deemed necessary.
Department Summary:
Responsible for maintaining and monitoring charges for 3 hospitals and all outpatient departments, following governmental regulatory guidelines. This department also assists HIM and ROI with system functions and implementations. As an integral part of the revenue cycle division, we are a go-to department for reporting and data mining in both multiple revenue cycle systems and EMR. Our department collaborates closely with IT, clinical staff and finance.
Qualifications:
- Minimum of 2 years billing or coding experience in a hospital or physician office setting
- Solid computer skills (Health Quest Medipac, Cerner, Microsoft TEAMS, Excel, Word, Power Point)
- Experience in hospital reimbursement, revenue audits or charge capture
- Knowledge of current Medicare and other regulatory billing guidelines
- Ability to manage multiple demands from a variety of constituents
- Health information or nursing professional helpful
- CCS, CCSP or Coding Certificate helpful
Skills:
- Good time management skills
- Critical Thinker
- Detail oriented
- Effective Communicator
- Comfortable speaking to large groups and presenting
- Ability to work independently or in a team environment
Responsibilities & Expectations:
- Review all clinical documentation daily for observation and inpatients for correct admission status
- Identify and correct all registration errors regarding account status
- Review all discharged observation and inpatient encounter documentation to charge drug administration/infusion charges according to coding guidelines
- Complete facility charge ticket on all ER admits for level charges and batch charge enter any procedures performed in the ER.
- Manual charge posting for ancillary departments that come via charge sheets
- Post facility charges for the HOPD offices
- Review charges on AI BOT list that need manually posted
- Review documentation on labor and delivery triage patients and post charges according to documentation.
- Assist manager with communication regarding clinical documentation in relation to charge capture.
- Understand and maintain a current knowledge of all regulations regarding observation billing and reimbursement.
- Daily tracking of all chart type counts
- Training of new colleagues and cross training when needed
- Maintain productivity and quality standards
- Accept change as needed to meet departmental goals
- Prepare or assist with other projects/duties assigned
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, disability, gender identity, sexual orientation or protected veteran status.
Working Conditions:
- Work eight hours a day Monday-Friday
- Flex time available
- May require occasional additional hours or paid overtime to handle peak volumes which may be outside the normal business hours of operation for the department
- Overtime only as needed
- At home-based work environment with flexibility after onsite training and competency established
- Some travel to various Aultman locations for meetings and projects
- Training on site when needed
- Minimal physical activity requirements
- or Coding Certificate helpful
