What are the responsibilities and job description for the HIM Specialist Appeals position at Jupiter Medical Center?
Ranked #1 for Safety, Quality and Patient Satisfaction, Jupiter Medical Center is the leading destination for world-class health care in Palm Beach County and the greater Treasure Coast.
Outstanding physicians, state-of-the-art facilities, innovative techniques and a commitment to serving the community enables Jupiter Medical Center to meet a broad range of patient needs. Jupiter Medical Center is the only hospital in Palm Beach, Martin, St. Lucie and Indian River counties to receive a 4-star quality and safety rating from the Centers for Medicare & Medicaid Services (CMS).
Education
Associate or bachelor's degree, 2 plus years' experience working acute care healthcare
Experience / Qualifications
2 plus years in Hospital Revenue Cycle experience
Knowledge of Government and Third-Party payor Regulations and Standards
Familiar with ICD10, CPT, HCPCS, revenue center and other billing requirements
Knowledge of ADRs, post payment audits and appeals processes, requirements and guidelines
Understand basic medical record documentation and EHR processing
Must be familiar with medical terminology, coding processes, clinical documentation and government and non-government reimbursement methodologies
Must be detail oriented, multi-task and be able to meet deadlines
Good computer skills with proficiency in windows, PDF tools and excel application, analytic and be able to create reports
Ability to present data to small groups
Position Summary
The HIM Appeals Specialist is responsible to assist department leadership in monitoring daily ADR, RAC and other Third-party request.
Responsibilities include :
Research each request to determine reason for record request and type of records necessary to support potential denial
Identify any potential opportunities for trends in documentation discrepancies, charging, coding or billing
Coordination of record processing, and sequencing records per the record request
Serves as a liaison between departments to request additional information, including physician practices
Research and investigate NCD / LCD for medical necessity, documentation requirements, units and other required coding / billing requirements and billing payors
Develops and prepares data / reports for monthly meetings and provides input on process improvement
Develops tools for departments to prevent future ADR / denials
Researches governmental and non-governmental payor regulations and policies and update key stakeholders
Report pending delays in processing request / follow up cases with Director HIM and adds notes to system for tracking purposes
Keeps Director and other key stakeholders on potential negative financial impact
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