What are the responsibilities and job description for the HIM Specialist 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
The HIM Appeals Specialist is responsible to assist department leadership in monitoring daily ADR, RAC and other Third-party request.
Responsibilities Include
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
- 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
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
- All other duties assigned
