Pre-Cert Specialist (FT)
POSITION SUMMARY
• Responsible for submitting/obtaining any required authorization/notification for tests performed; to insure proper reimbursement of claims.
• Also responsible for scheduling patients for tests.
OVERVIEW
• The evaluation is to assure individual performance, departmental goals and organizational goals are aligned. It is designed to support communication between the manager and the employee. Employee perception of their own performance is very important. To maximize the benefit of this process, both the manager and the employee participate in the evaluation process.
QUALIFICATIONS
A. Knowledge, Skills and Abilities
• Excellent customer service skills.
• Reads and understands the English language.
• Ability to think critically and analytically with little or no supervision
• Ability to work effectively in situations of high stress and conflict and communicate goals and outcomes.
• Ability to process information and prioritize
• Possesses exceptional verbal and written communication skills
• Possesses independent work habits, is self-reliant and self-directed
• Ability to learn, adapt, and change as required by the job functions
• Ability to maintain absolute confidentiality of material and information accessed and reviewed
• Basic computer literacy
• Ability to move freely, reach, bend, and complete light lifting
• Ability to use good body mechanics while performing daily job functions and ability to follow specific OSHA guidelines
• Ability to maintain attendance to meet standard job practices
B. Education
• High School Graduate or G.E.D. required.
C. Licensure
• N/A
D. Experience
• Minimum of five years experience is required in medical or financial field.
• Pre-certification experience preferred.
• Certified or Registered Medical Assistant Preferred
E. Interpersonal skills
F. Essential technical/motor skills
G. Essential physical requirements
• Sedentary: Exert up to 10 lb. of force occasionally and/or a minute amount frequently - >75%
H. Essential mental requirements
I. Essential sensory requirements
J. Other
• Basic understanding of Medicaid, Medicare and Commercial Insurance guidelines.
• Analytical and organizational skills must be above average.
• Attention to detail, communication, and documentation skills must be excellent.
• Prior public relation experience is required.
• Operations of computer systems and business machinery also required.
• Must have the ability to communicate in a courteous manner and possess excellent telephone communication skills with the ability to remain calm in difficult situations.
• Must have the ability to talk with public in a professional manner and be able to interpret patient clinical information, charges and explain in detail.
• Must have excellent interpersonal communication skills and possess professional and neat appearance.
K. Equipment used
OTHER QUALIFICATIONS
A. Exposure to hazards (body fluid exposure level)
• Level III
B. Age of Patient Populations Served
• Adolescents 13 - 18 years
• Adults 19 - 70 years
• Geriatrics - 70+ years
JOB SPECIFIC DUTIES AND PERFORMANCE STANDARDS
• Below are those tasks, duties, and responsibilities that comprise the means of accomplishing the position’s purpose and objectives. These are critical or fundamental to the performance of the position. They are the major functions for which the person in the position is held accountable. Following are the essential functions of the position, along with the corresponding performance standards.
o Major Task, Duties, and Responsibilities
Initiates contact to insurance company, including use of internet to obtain correct patient benefit information, including deductible and co insurance amount of patient liability and certification requirements.
Responsible for contacting insurance company or authorized representative to provide clinical information needed to obtain authorization for medical services to be provided by CRMC.
Responsible for obtaining needed clinical information from physician office to facilitate authorization requirements, by maintaining open communication with physician offices.
Responsible for updating schedule and contacting patient and physician office with necessary changes due to authorization requirements.
Ensure all physician orders meet current standards and policies. Obtain clarification of orders from physician office.
Responsible for cross training in Patient Access registration and must accurately update patient demographic and insurance information as necessary when patient contact is possible.
Determines primary insurance liability in cases requiring coordination of benefits (spouse, dependent child).
Initiates communication to coworkers in the event of limited or lack of insurance benefits.
Maintains acceptable accuracy rate based on Patient Access guidelines. Obtains education and reviews accuracy as needed and provided by Patient Access Quality Assurance personnel.
Responsible for cross training in Scheduling in order to assist co workers during absences and as workload needs arise.
Reviews prior accounts and makes recommendations for their resolution as defined in hospital's policy and procedures.
Refers potential Medicaid patients to Medicaid Benefit Specialist for screening process.
Notifies the physician's office of any potential delay or change in procedure due to certification requirements. Ensure all physician orders meet current standards and policies. Obtain clarification of orders from physician office.
Documents all contact with patients, family, employers and third party payers in the appropriate HIS system.
Continues to stay informed of any policy or regulation changes that could affect collection of receivables. Updates personal manual with current revisions of policies, reviews Communication Board and monitors electronic mail for current regulations.
Answers telephone professionally and courteously. Answers all inquiries in a courteous and timely manner.
Documents all patient complaints through use of appropriate system.
Understands the significance of the organization's Performance Improvement Programs and is an active participant.
Complies with all departmental policies of Patient Access.
Reports any problems to immediate supervisor daily as needed.
Responsible for any and all other functions as required and directed by Supervisor, in a willing and positive manner.
Coordinates scheduled absences with co-workers to provide adequate coverage for department.
o Accuracy
Maintains appropriate accuracy rate in accordance with the guidelines of Patient Access.
Notifies physician offices of pre-certification/authorization issues in a timely manner to prevent unauthorized procedures from being completed.
Completes 95% accuracy for pre-certifications/authorizations.
o Ability to produce workable ideas and techniques, willingness to attempt new approaches and perform job duties independently.
Performs duties in an independent manner with minimal direct supervision.
Can solve day to day problems within scope of practice and make decisions in a timely manner.
Offers workable ideas, concepts and techniques to improve productivity.
Willing to attempt new job duties, tasks, etc.
Maintains regulatory requirements including all state, federal and Joint Commission regulations related to Patient Financial Services and, as appropriate, to the facility.
Performs any other task as requested by Supervisor or Management in a willing and positive manner.
Coffee Regional Medical Center
Coder
POSITION SUMMARY
• Under general supervision and according to established procedures, assigns diagnostic codes to medical record information.
• Codes charts under the ICD-9-CM and HCPCS System for statistical and DRG assignment purposes.
• Abstracts required data into hospital abstracting system.
• The outcome of information gathered is used to determine the hospital database and reimbursement of hospital claims.
• Responsible for timely review of patient records in order to identify an appropriate selection of codes which will accurately reflect the reason for admission, extent of care received, and level of severity of illness.
OVERVIEW
• The evaluation is to assure individual performance, departmental goals and organizational goals are aligned. It is designed to support communication between the manager and the employee. Employee perception of their own performance is very important. To maximize the benefit of this process, both the manager and the employee participate in the evaluation process.
QUALIFICATIONS
A. Knowledge, Skills and Abilities
• Excellent customer service skills.
• Reads and understands the English language.
• Ability to think critically and analytically with little or no supervision
• Ability to work effectively in situations of high stress and conflict and communicate goals and outcomes.
• Ability to process information and prioritize
• Possesses exceptional verbal and written communication skills
• Possesses independent work habits, is self-reliant and self-directed
• Ability to learn, adapt, and change as required by the job functions
• Ability to maintain absolute confidentiality of material and information accessed and reviewed
• Basic computer literacy
• Ability to move freely, reach, bend, and complete light lifting
• Ability to use good body mechanics while performing daily job functions and ability to follow specific OSHA guidelines
• Ability to maintain attendance to meet standard job practices
B. Education
• High School diploma or GED
• Equivalent to an associate's degree in medical terminology (with course work in medical terminology, anatomy, physiology, disease processes, ICD-9-CM coding and prospective payment) preferred.
C. Licensure
D. Experience
• Six (6) to twelve (12) months experience in ICD-9-CM and CPT-4 coding in acute care facility preferred.
• Eligible for designation as a RHIT, RHIA, CCA, CCS-P or CCS preferred.
• Basic computer skills preferred.
E. Interpersonal skills
F. Essential technical/motor skills
G. Essential physical requirements
• Sedentary: Exert up to 10 lb. of force occasionally and/or a minute amount frequently - 1-24%
• Light: Exert up to 20 lb. of force occasionally and/or up to 10 lb. of force frequently - 1-24%
• Medium: Exert 20 – 50 lb. of force occasionally and/or up to 15 lb. of force frequently - 1-24%
• Heavy: Exert 50 – 100 lb. of force occasionally and/or up to 30 lb. of force frequently - N/A
• Very Heavy: Exceed 100 lb. of force occasionally and/or 50 lb. frequently - N/A
H. Essential mental requirements
I. Essential sensory requirements
J. Other
• Good verbal, written and computer communications skills
• Ability to work harmoniously with others
• Detail oriented
• Ability to work with physicians in a collaborative manner
K. Equipment used
OTHER QUALIFICATIONS
A. Exposure to hazards (body fluid exposure level)
• Level III
B. Age of Patient Populations Served
• No patient contact
JOB SPECIFIC DUTIES AND PERFORMANCE STANDARDS
• Below are those tasks, duties, and responsibilities that comprise the means of accomplishing the position’s purpose and objectives. These are critical or fundamental to the performance of the position. They are the major functions for which the person in the position is held accountable. Following are the essential functions of the position, along with the corresponding performance standards.
o Professional Requirements
Maintains regulatory requirements including all state, federal, and Joint Commission regulations related to Health Information Services, as appropriate, to the facility.
Maintains patient confidentiality at all times. Complies with all HIPAA Policies and Procedures, specifically with the use of "minimum necessary information" to perform job duties.
Maintains an organized and clean work area.
Actively participates in performance improvement and continuous quality improvement activities.
Must be familiar with the following Policy and Procedures: Administration, HIS, Infection Control, Emergency Preparedness and Safety, and HIPAA. Ensures compliance with policies and procedures.
o Analyzes patient medical records and interprets documentation to identify all diagnoses and procedures. Assigns proper ICD-9-CM and HCPCS diagnostic and operative procedure codes to charts and related records by reference to designated coding manuals and other reference material.
Codes a minimum of the following: 3 inpatient records, 4 OPO/OPS, 15 emergency department records, and 30 other outpatient records per hour.
Maintains within five days after discharge coding requirements.
o Applies uniform hospital discharge data-set definitions to select the principal diagnoses, principal procedure, and other diagnoses and procedures that require coding, as well as other data items required to maintain the hospital database.
Verifies that coded information is entered into the database without any errors within five days of patient discharge.
o Applies sequencing guidelines to coded data according to official coding rules.
o Assigns DRG code to each record according to healthcare finance-administration directives. Enters coded/abstracted information into DRG grouper, analyzes groupings, and observes for assigned appropriate DRG weight for reimbursement.
Identifies any and all complications or comorbidities.
Utilizes the computerized coding/abstracting equipment appropriately.
o Assesses the adequacy of medical record documentation to ensure that it supports the principal diagnoses, principal procedure, complications, and comorbid conditions assigned codes. Consults with the appropriate physician to clarify medical record information.
Identifies any documentation inadequacies with physician and clarifies medical record information.
o Answers physicians/clinicians questions regarding coding principles, DRG assignment, and prospective payment system. Assists finance data processing, and other departments with coding/DRG issues.
Assists physicians and ancillary departments with coding questions with timeliness, courtesy, and tact.
o Remains abreast of developments in medical record technology by pursuing a program of professional growth and development, attending educational programs and meetings, reviewing pertinent literature, and so forth.
Utilizes professional affiliations, etc., in order to stay current in professional developments.
Attends all pertinent coding seminars.
Maintains updated coding books.
o Works with the Coding Manager to identify and resolve coding issues.
Attends staff meetings as directed by the Coding Manager.
o Reports all aged accounts to the HIS Supervisor. Works with HIS Staff and/or Physician to obtain all necessary documentation to code all accounts in a timely manner.
Maintains a listing of aged accounts and documentation of steps taken to obtain necessary documentation.
Keeps Supervisor informed of all aged accounts.
o Functions as a role model for current and new staff.
Accepts assignment as preceptor for new staff.
Facilitates problem resolution among peers as observed by manager and peers.
Demonstrates a constructive approach during all interactions with staff and nurse manager toward the organization.
o Actively participates in service, departmental, and hospital-wide committees as assigned, providing on-going communication to those one represents.
Attends 75% of scheduled meetings as evidence by minutes.
Actively participates, as evidenced by project involvement related to committees' purpose/ responsibilities, as evidenced by bimonthly project updates or monthly operational reports.
o Attends all required safety training programs and can describe his/her responsibilities related to general safety, department/service safety, and specific job related hazards.
Attends safety education programs.
Provides complete and accurate responses to safety questions.
Operates assigned equipment and performs all procedures in a safe manner as instructed.
Maintains work area and equipment in condition required by department standards.
Demonstrates proper body mechanics in all functions.
Effectively utilizes unit manuals as resources in order to clarify and/or resolve hospital policy issues.
o Demonstrates respect and regard for the dignity of all patients, families, visitors, and fellow employees to ensure a professional, responsible, and courteous environment.
Interacts with all of the above in a considerate, helpful, and courteous manner as observed by nurse manager and peers.
Fosters mature professional relationships with fellow employees in a courteous, friendly manner as measured by management observation and peer input.
Maintains professional composure and confidence during stressful situations.
Maintains open communication using appropriate chain of command regarding issues.
Conducts all work activities with respect for rights and wishes of patients, visitors, families, and fellow employees.
Maintains confidentiality of all hospital and patient information at all times.
Presents neat appearance in proper attire and identification as required by hospital policy.
Displays a positive attitude that contributes to the overall customer service program in place at the hospital.
o Promotes effective working relations and works effectively as part of a department/unit team to facilitate the department's/unit's ability to meet its goals and objectives.
Participates in staff meetings as required
Supports the hospital's mission, policies, and programs through attendance and participation at committee meetings.
Demonstrates ability to use the computer system.
Completes work assignments on time/readily accepts assignments as observed by supervisor/director.
Reports to work on time and is at work as scheduled, as observed by supervisor/director.
REGULATORY COMPLIANCE
• Below are any additional competencies as related to regulatory compliance that are specific to the job title and not listed in the other sections of the document.
EDUCATION AND COMPETENCY
• Attends all mandatory and department-specific education and training programs as required.
•
Attends all required education and training and can describe his/her responsibilities related to department safety and specific job related hazards.
•
Has met all required competencies for the evaluation period as evidenced by job specific competency evaluations...
Coffee Regional Medical Center
Financial Counselor (FT)
POSITION SUMMARY
• Timely and accurate compilation of patient socio-demographic and insurance data at the time of service. Arranges for the efficient and orderly admission of pediatric, adolescent, adult and geriatric patients to all entry points of admission. Makes patients and families aware of hospital policies and procedures. Effectively, yet professionally, request and collect patient estimated balances, including co-payments and deductibles. Will ensure managed care requirements and pre-certification/authorization needs are met prior to patient admission. Assist with flow of data between physicians, their offices, nursing units, ancillary areas, business office services, insurance companies and patient’s while insuring patient confidentiality is not breached. The duties of this position require the exercise of courtesy and patience in speaking with patients, families, co-workers, employers, state agencies and others to maintain sound public relations. Must comply with Confidentiality guidelines in accordance to CRMC policies and procedures. Must maintain regular consistent attendance, personal appearance, punctuality and adherence to applicable health and safety guidelines.
OVERVIEW
• The evaluation is to assure individual performance, departmental goals and organizational goals are aligned. It is designed to support communication between the manager and the employee. Employee perception of their own performance is very important. To maximize the benefit of this process, both the manager and the employee participate in the evaluation process.
QUALIFICATIONS
A. Knowledge, Skills and Abilities
• Excellent customer service skills.
• Reads and understands the English language.
• Ability to think critically and analytically with little or no supervision
• Ability to work effectively in situations of high stress and conflict and communicate goals and outcomes.
• Ability to process information and prioritize
• Possesses exceptional verbal and written communication skills
• Possesses independent work habits, is self-reliant and self-directed
• Ability to learn, adapt, and change as required by the job functions
• Ability to maintain absolute confidentiality of material and information accessed and reviewed
• Basic computer literacy
• Ability to move freely, reach, bend, and complete light lifting
• Ability to use good body mechanics while performing daily job functions and ability to follow specific OSHA guidelines
• Ability to maintain attendance to meet standard job practices
B. Education
• High School Graduate of GED required.
• Vocational-tech/college preferred.
• CPAR/CFC Certification preferred.
• Must be able to efficiently master departmental competency within 45 days after employment.
C. Licensure
• CPAR and/or CFC preferred
D. Experience
• Knowledge of Third-party payers, billing requirements and reimbursement methods, 3+ years of previous hospital/medical office experience. Previous data entry/programming or office coordinator experience highly preferred. CPAR/CFC Certification preferred. Prior billing/collections or financial counseling experience preferred. Knowledge of, or coursework in; medical terminology is preferred.
E. Interpersonal skills
• Customer Service ("face to face/interacting with the public") experience required. Must maintain regular consistent attendance, personal appearance, punctuality and adherence to applicable health and safety guidelines. Effective professional communication skills. Proper written and spoken usage of the English language. Spanish bilingual highly desirable.
F. Essential technical/motor skills
• Computer experience required Microsoft Suite of Products: Word and Excel. Ability to type 40+ WPM accurately and ability to use of number keypad. Analytical and organizational skills must be above average. Basic mathematical skills required.
G. Essential physical requirements
• Sedentary: Exert up to 10 lb. of force occasionally and/or a minute amount frequently - 50-74%
• Light: Exert up to 20 lb. of force occasionally and/or up to 10 lb. of force frequently - 25-49%
• Medium: Exert 20 – 50 lb. of force occasionally and/or up to 15 lb. of force frequently - 1-24%
• Heavy: Exert 50 – 100 lb. of force occasionally and/or up to 30 lb. of force frequently - 1-24%
• Very Heavy: Exceed 100 lb. of force occasionally and/or 50 lb. frequently - 1-24%
H. Essential mental requirements
• Ability to read and comprehend simple instructions, short correspondence, and memos.Ability to write simple correspondence. Analytical and organizational skills must be above average.
I. Essential sensory requirements
• Ability to visually assess if a patient demonstrates symptoms that would require emergency treatment and care. Notify appropriate clinical staff to assess patient.
J. Other
• Hours- Must be flexible to work in different areas and locations as needed. This will include the ability to work all shifts including nights, weekends and holidays. Available to come in at short notice and maintain an on-call rotation. Expected to work 40 hours per week and overtime based on the demand and need of the department.
K. Equipment used
• HIS system, computer, fax, VOIP, phone system, headset system, speakers, billing and POS collections systems.
OTHER QUALIFICATIONS
A. Exposure to hazards (body fluid exposure level)
• Level III
B. Age of Patient Populations Served
• Neonates 1 - 30 days
• Infants 30 days - 1 year
• Children 1 - 12 years
• Adolescents 13 - 18 years
• Adults 19 - 70 years
• Geriatrics - 70+ years
JOB SPECIFIC DUTIES AND PERFORMANCE STANDARDS
• Below are those tasks, duties, and responsibilities that comprise the means of accomplishing the position’s purpose and objectives. These are critical or fundamental to the performance of the position. They are the major functions for which the person in the position is held accountable. Following are the essential functions of the position, along with the corresponding performance standards.
• Registration Duties
o Use scripting policies as an effective communication tool with customers. Greet patients in accordance with the department's script policy and procedure.
o Responsible and accountable for tasks necessary to properly identify and register into the patient processing system all patients presenting for admission.
o Ability to complete scheduling, registration, precertification, financial counseling, medical necessity checks effectively all patient types in the HIS system.
o Distribute necessary paperwork and forms to each patient registered including information on Advanced Directives, Patient Rights and Responsibilities, and Important Message from Medicare with complete and detailed explanation.
o Must keep abreast of current regulatory requirements, including all state, federal and JCAHO regulations. Keep up to date of requirements from each insurance payor (Medicare, Medicaid, Managed Care, Commercial or private payors, Tricare, etc.). Adhere to external agency regulations. Demonstrate the ability to complete meet the requirements of each payor according to their guidelines.
o Responsible for documenting all contact with patients, family, employers and third party payors.
o Insure patient flow through the registration process is professional, patient friendly and within department established time standards.
o Facilitate patient paper flow for accurate and complete medical records, financial forms and patient admission to nursing or ancillary units. Obtain authorized signatures on all required forms (Conditions of Admission, Important Message from Medicare, etc…).
o Ensure all physician orders meet current standards and policies. Obtain clarification on unclear or inappropriate orders. Determine proper patient processing according to physician orders. Appropriately enters the physician into the HIS system.
o Accurately transfer, and/or discharge, place orders, etc... for patients according to doctor's orders, and according to established policies and procedures.
o Demonstrates ability to complete status changes, upgrades, system change request according to policy and procedure.
• POS Collections
o Protect the financial standing of the hospital by appropriately determining financial responsibility. Contributes to department goals by making 100% of financial arrangements for each patient prior to services being performed.
o Review patient account history to establish acceptable payment arrangements, charity assistance or agency referral notifications. Refers accounts with bad debt history to the Patient Financial Services office or accounting representatives. Effectively calculate patient liability by reviewing patient insurance benefits. Effectively financial counsel patients for estimated patient liability.
o Collects account deposits on patient estimated balances, co-pays, co-insurance and unpaid deductibles. Meet collection goals as outlined by departmental policy and procedure.
o Initiates medically needy application for charity, catastrophic and indigent write-offs. Refers potential Medicaid patients to Medicaid Benefit Specialist for screening process.
o Review all responsible party demographics for useful collection purposes from all available sources (EX.-in-house computer systems, credit reports, outside sources).
o Completes all necessary forms (write off sheets, promissory notes, receipts, credit card reports, ABNs, etc…). Forwards to necessary departments. Initiates medical necessity check. Documents encounters in the HIS system.
o Makes deposits of money collected and receipts daily in department safe according to policy and procedure.
o Is able to explain all aspects of the billing account and procedure to a patient/guarantor.
• Accuracy , Insurance Billing and Precertification
o Maintains acceptable accuracy rate according to departmental guidelines.
o Meets with Education Coordinator weekly to discuss errors. Seeks ways to improve accuracy.
o Verify complete patient, guarantor and relative information. Makes every attempt to ensure proper patient identification using all possible means including, but not restricted to patient and guarantor social security number legal name, date of birth and address. Must adhere to Patient ID policy for identifying and updating patient information.
o Identify third party payor coverage, secures prior authorizations, referrals, notifications and precertification requirements prior to patient admission. Ensures fax notifications are complete.
o Maintains working knowledge of major third-party payer regulations and compliance issues.
o Distribute appropriate information to patients according to pay source, including to, but not restricted to Medicare, Medicaid, and Champus.
o Obtain incorrect or missing information in the insurance processor. Corrects accounts appropriately according to guidelines.
o Able to obtain and verify insurance benefits and eligibility. Methods available include patient/guarantor, insurance card or electronic means.
• Other Duties
o Follow proper chain of command for issues, complaints, etc.
o Demonstrates ability to respond appropriately to department and facility codes.
o Assist in orientation and training of new staff members. Able to help evaluate new staff member for readiness to fulfill job duties independently.
o Obtain room assignment from admissions nurse, patient care director or nursing unit according to doctor's orders.
o Escort patients to ancillary service department after the registration process is completed. Assure that each patient admitted to a bed is escorted to ancillary services and to the nursing unit in a wheelchair.
o Able to perform switchboard duties according to department policies and procedures.
o Complies with Time and Attendance according to policy and procedure. Attends to personal affairs to avoid conflicts with work. Schedules days off prior to posting of new schedule.
o Refill supplies in copier, printer, and fax machines at end of each shift.
o Perform any other task requested from Supervisor or Management in a willing and positive manner.
Certified Coder Specialist (FT)
POSITION SUMMARY
• Under general supervision and according to established procedures, assigns diagnostic codes to medical record information.
• Codes charts under the ICD-10-CM and ICD-10-PCS (HCPCS) System for statistical and DRG assignment purposes.
• Abstracts required data into hospital abstracting system.
• The outcome of information gathered is used to determine the hospital databse and reimbursement of hospital claims.
• Responsible for timely review of patient records in order to identify an appropriate selection of codes which will accurately reflect the reason for admission, extent of care received, and level of severity of illness.
OVERVIEW
• The evaluation is to assure individual performance, departmental goals and organizational goals are aligned. It is designed to support communication between the manager and the employee. Employee perception of their own performance is very important. To maximize the benefit of this process, both the manager and the employee participate in the evaluation process.
RATING SCALE DEFINITION
• Needs Improvement – Performance is consistently below requirements/expectations. Immediate improvement is necessary.
o There are shortfalls in meeting the standard, criteria or objective.
o The employee requires close supervision or step-by-step guidance for this task.
o There is room for significant improvement before moving to the “meets expectation” level.
o Employee may have work improvement plan in place for this standard or objective.
•
Meets Expectations – Performance meets all established standards and sometimes exceeds them. Activities contribute to increased unit/department results. Employees consistently complete the work that is required and at times go beyond expectations.
o Employee reached the expected level of performance.
o Performance is solid, effective and consistently meets the standards as required by the job.
o Performance is what can be expected of a fully qualified and experienced person.
o Under normal supervision and follow-up, tasks are completed on schedule and in keeping with expected results.
•
Excels – Outstanding performance.
o Performance consistently surpasses all established standards.
o Activities often contribute to improved or innovative work practices.
o People often seek out the employee for assistance in this area.
o Employee rarely requires supervision or follow-up.
•
Not Applicable – Item does not apply to this job.
QUALIFICATIONS
A. Knowledge, Skills and Abilities
• Excellent customer service skills.
• Reads and understands the English language.
• Ability to think critically and analytically with little or no supervision.
• Ability to work effectively in situations of high stress and conflict and communicate goals and outcomes.
• Ability to process information and prioritize.
• Possesses exceptional verbal and written communication skills.
• Possesses independent work habits, is self-reliant and self-directed.
• Ability to learn, adapt, and change as required by the job functions.
• Ability to maintain absolute confidentiality of material and information accessed and reviewed.
• Basic computer literacy
• Ability to move freely, reach, bend, and complete light lifting.
• Ability to use good body mechanics while performing daily job functions and ability to follow specific OSHA guidelines.
• Ability to maintain attendance to meet standard job practices.
B. Education
• High School diploma or GED
• Equivalent to an associate degree in medical terminology (with course work in medical terminology, anatomy, physiology, disease processes, ICD-10-CM coding and prospective payment) preferred.
C. Licensure
• Certified Coding Specialist/CCS
• Eligible for designation as a RHIT or RHIA preferred.
D. Experience
• One year experience in ICD-10-CM and ICD-10-PCS and CPT-4 coding in acute care facility.
E. Interpersonal skills
F. Essential technical/motor skills
G. Essential physical requirements
• Sedentary: Exert up to 10 lb. of force occasionally and/or a minute amount frequently - greater than 75%
H. Essential mental requirements
I. Essential sensory requirements
J. Other
• Good verbal, written and computer communications skills.
• Ability to work harmoniously with others.
• Detail oriented
• Ability to work with physicians in a collaborative manner.
K. Equipment used.
OTHER QUALIFICATIONS
A. Exposure to hazards (body fluid exposure level)
• Level III
B. Age of Patient Populations Served
• No patient contacts.
JOB SPECIFIC DUTIES AND PERFORMANCE STANDARDS
• Below are those tasks, duties, and responsibilities that comprise the means of accomplishing the position’s purpose and objectives. These are critical or fundamental to the performance of the position. They are the major functions for which the person in the position is held accountable. Following are the essential functions of the position, along with the corresponding performance standards.
o Professional Requirements
Maintains regulatory requirements including all state, federal, and Joint Commission regulations related to Health Information Services, as appropriate, to the facility.
Always maintains patient confidentiality. Complies with all HIPAA Policies and Procedures, specifically with the use of "minimum necessary information" to perform job duties.
Maintains an organized and clean work area.
Actively participates in performance improvement and continuous quality improvement activities.
Must be familiar with the following Policy and Procedures: Administration, HIS, Infection Control, Emergency Preparedness and Safety, and HIPAA. Ensures compliance with policies and procedures.
o Analyzes patient medical records and interprets documentation to identify all diagnoses and procedures. Assigns proper ICD-10-CM, ICD-10-PCS and HCPCS diagnostic and operative procedure codes to charts and related records by reference to designated coding manuals and other reference material.
Codes a minimum of the following: 3 inpatient records, 3 OPO/ OPS, 12 emergency department records, and 30 other outpatient records per hour.
Maintains within five days after discharge coding requirements.
Applies uniform hospital discharge data-set definitions to select the principal diagnoses, principal procedure, and other diagnoses and procedures that require coding, as well as other data items required to maintain the hospital database.
Verifies that coded information is entered into the database without any errors within five days of patient discharge.
o Applies sequencing guidelines to coded data according to official coding rules.
Assigns DRG code to each record according to healthcare finance-administration directives. Enters coded/abstracted information into DRG grouper, analyzes groupings, and observes for assigned appropriate DRG weight for reimbursement.
Identifies any and all complications or co morbidities.
Utilizes the computerized coding/abstracting equipment appropriately.
Assesses the adequacy of medical record documentation to ensure that it supports the principal diagnoses, principal procedure, complications, and comorbid conditions assigned codes. Consults with the appropriate physician to clarify medical record information.
Identifies any documentation inadequacies with physician and clarifies medical record information.
o Answers physicians/clinicians’ questions regarding coding principles, DRG assignment, and prospective payment system. Assists finance data processing, and other departments with coding/DRG issues.
Assists physicians and ancillary departments with coding questions with timeliness, courtesy, and tact.
Remains abreast of developments in medical record technology by pursuing a program of professional growth and development, attending educational programs and meetings, reviewing pertinent literature, and so forth.
Utilizes professional affiliations, etc., in order to stay current in professional developments.
Attends all pertinent coding seminars.
Maintains updated coding books.
o Works with the Coding Manager to identify and resolve coding issues.
Attends staff meetings as directed by the Coding Manager.
Reports all aged accounts to the HIS Supervisor. Works with HIS Staff and/or Physician to obtain all necessary documentation to code all accounts in a timely manner.
Maintains a listing of aged accounts and documentation of steps taken to obtain necessary documentation.
Keeps Supervisor informed of all aged accounts.
Pre-Cert Specialist (FT)
POSITION SUMMARY
• Responsible for submitting/obtaining any required authorization/notification for tests performed; to insure proper reimbursement of claims.
• Also responsible for scheduling patients for tests.
OVERVIEW
• The evaluation is to assure individual performance, departmental goals and organizational goals are aligned. It is designed to support communication between the manager and the employee. Employee perception of their own performance is very important. To maximize the benefit of this process, both the manager and the employee participate in the evaluation process.
QUALIFICATIONS
A. Knowledge, Skills and Abilities
• Excellent customer service skills.
• Reads and understands the English language.
• Ability to think critically and analytically with little or no supervision
• Ability to work effectively in situations of high stress and conflict and communicate goals and outcomes.
• Ability to process information and prioritize
• Possesses exceptional verbal and written communication skills
• Possesses independent work habits, is self-reliant and self-directed
• Ability to learn, adapt, and change as required by the job functions
• Ability to maintain absolute confidentiality of material and information accessed and reviewed
• Basic computer literacy
• Ability to move freely, reach, bend, and complete light lifting
• Ability to use good body mechanics while performing daily job functions and ability to follow specific OSHA guidelines
• Ability to maintain attendance to meet standard job practices
B. Education
• High School Graduate or G.E.D. required.
C. Licensure
• N/A
D. Experience
• Minimum of five years experience is required in medical or financial field.
• Pre-certification experience preferred.
• Certified or Registered Medical Assistant Preferred
E. Interpersonal skills
F. Essential technical/motor skills
G. Essential physical requirements
• Sedentary: Exert up to 10 lb. of force occasionally and/or a minute amount frequently - >75%
H. Essential mental requirements
I. Essential sensory requirements
J. Other
• Basic understanding of Medicaid, Medicare and Commercial Insurance guidelines.
• Analytical and organizational skills must be above average.
• Attention to detail, communication, and documentation skills must be excellent.
• Prior public relation experience is required.
• Operations of computer systems and business machinery also required.
• Must have the ability to communicate in a courteous manner and possess excellent telephone communication skills with the ability to remain calm in difficult situations.
• Must have the ability to talk with public in a professional manner and be able to interpret patient clinical information, charges and explain in detail.
• Must have excellent interpersonal communication skills and possess professional and neat appearance.
K. Equipment used
OTHER QUALIFICATIONS
A. Exposure to hazards (body fluid exposure level)
• Level III
B. Age of Patient Populations Served
• Adolescents 13 - 18 years
• Adults 19 - 70 years
• Geriatrics - 70+ years
JOB SPECIFIC DUTIES AND PERFORMANCE STANDARDS
• Below are those tasks, duties, and responsibilities that comprise the means of accomplishing the position’s purpose and objectives. These are critical or fundamental to the performance of the position. They are the major functions for which the person in the position is held accountable. Following are the essential functions of the position, along with the corresponding performance standards.
o Major Task, Duties, and Responsibilities
Initiates contact to insurance company, including use of internet to obtain correct patient benefit information, including deductible and co insurance amount of patient liability and certification requirements.
Responsible for contacting insurance company or authorized representative to provide clinical information needed to obtain authorization for medical services to be provided by CRMC.
Responsible for obtaining needed clinical information from physician office to facilitate authorization requirements, by maintaining open communication with physician offices.
Responsible for updating schedule and contacting patient and physician office with necessary changes due to authorization requirements.
Ensure all physician orders meet current standards and policies. Obtain clarification of orders from physician office.
Responsible for cross training in Patient Access registration and must accurately update patient demographic and insurance information as necessary when patient contact is possible.
Determines primary insurance liability in cases requiring coordination of benefits (spouse, dependent child).
Initiates communication to coworkers in the event of limited or lack of insurance benefits.
Maintains acceptable accuracy rate based on Patient Access guidelines. Obtains education and reviews accuracy as needed and provided by Patient Access Quality Assurance personnel.
Responsible for cross training in Scheduling in order to assist co workers during absences and as workload needs arise.
Reviews prior accounts and makes recommendations for their resolution as defined in hospital's policy and procedures.
Refers potential Medicaid patients to Medicaid Benefit Specialist for screening process.
Notifies the physician's office of any potential delay or change in procedure due to certification requirements. Ensure all physician orders meet current standards and policies. Obtain clarification of orders from physician office.
Documents all contact with patients, family, employers and third party payers in the appropriate HIS system.
Continues to stay informed of any policy or regulation changes that could affect collection of receivables. Updates personal manual with current revisions of policies, reviews Communication Board and monitors electronic mail for current regulations.
Answers telephone professionally and courteously. Answers all inquiries in a courteous and timely manner.
Documents all patient complaints through use of appropriate system.
Understands the significance of the organization's Performance Improvement Programs and is an active participant.
Complies with all departmental policies of Patient Access.
Reports any problems to immediate supervisor daily as needed.
Responsible for any and all other functions as required and directed by Supervisor, in a willing and positive manner.
Coordinates scheduled absences with co-workers to provide adequate coverage for department.
o Accuracy
Maintains appropriate accuracy rate in accordance with the guidelines of Patient Access.
Notifies physician offices of pre-certification/authorization issues in a timely manner to prevent unauthorized procedures from being completed.
Completes 95% accuracy for pre-certifications/authorizations.
o Ability to produce workable ideas and techniques, willingness to attempt new approaches and perform job duties independently.
Performs duties in an independent manner with minimal direct supervision.
Can solve day to day problems within scope of practice and make decisions in a timely manner.
Offers workable ideas, concepts and techniques to improve productivity.
Willing to attempt new job duties, tasks, etc.
Maintains regulatory requirements including all state, federal and Joint Commission regulations related to Patient Financial Services and, as appropriate, to the facility.
Performs any other task as requested by Supervisor or Management in a willing and positive manner.
Coffee Regional Medical Center
Financial Counselor (FT)
POSITION SUMMARY
• Timely and accurate compilation of patient socio-demographic and insurance data at the time of service. Arranges for the efficient and orderly admission of pediatric, adolescent, adult and geriatric patients to all entry points of admission. Makes patients and families aware of hospital policies and procedures. Effectively, yet professionally, request and collect patient estimated balances, including co-payments and deductibles. Will ensure managed care requirements and pre-certification/authorization needs are met prior to patient admission. Assist with flow of data between physicians, their offices, nursing units, ancillary areas, business office services, insurance companies and patient’s while insuring patient confidentiality is not breached. The duties of this position require the exercise of courtesy and patience in speaking with patients, families, co-workers, employers, state agencies and others to maintain sound public relations. Must comply with Confidentiality guidelines in accordance to CRMC policies and procedures. Must maintain regular consistent attendance, personal appearance, punctuality and adherence to applicable health and safety guidelines.
OVERVIEW
• The evaluation is to assure individual performance, departmental goals and organizational goals are aligned. It is designed to support communication between the manager and the employee. Employee perception of their own performance is very important. To maximize the benefit of this process, both the manager and the employee participate in the evaluation process.
QUALIFICATIONS
A. Knowledge, Skills and Abilities
• Excellent customer service skills.
• Reads and understands the English language.
• Ability to think critically and analytically with little or no supervision
• Ability to work effectively in situations of high stress and conflict and communicate goals and outcomes.
• Ability to process information and prioritize
• Possesses exceptional verbal and written communication skills
• Possesses independent work habits, is self-reliant and self-directed
• Ability to learn, adapt, and change as required by the job functions
• Ability to maintain absolute confidentiality of material and information accessed and reviewed
• Basic computer literacy
• Ability to move freely, reach, bend, and complete light lifting
• Ability to use good body mechanics while performing daily job functions and ability to follow specific OSHA guidelines
• Ability to maintain attendance to meet standard job practices
B. Education
• High School Graduate of GED required.
• Vocational-tech/college preferred.
• CPAR/CFC Certification preferred.
• Must be able to efficiently master departmental competency within 45 days after employment.
C. Licensure
• CPAR and/or CFC preferred
D. Experience
• Knowledge of Third-party payers, billing requirements and reimbursement methods, 3+ years of previous hospital/medical office experience. Previous data entry/programming or office coordinator experience highly preferred. CPAR/CFC Certification preferred. Prior billing/collections or financial counseling experience preferred. Knowledge of, or coursework in; medical terminology is preferred.
E. Interpersonal skills
• Customer Service ("face to face/interacting with the public") experience required. Must maintain regular consistent attendance, personal appearance, punctuality and adherence to applicable health and safety guidelines. Effective professional communication skills. Proper written and spoken usage of the English language. Spanish bilingual highly desirable.
F. Essential technical/motor skills
• Computer experience required Microsoft Suite of Products: Word and Excel. Ability to type 40+ WPM accurately and ability to use of number keypad. Analytical and organizational skills must be above average. Basic mathematical skills required.
G. Essential physical requirements
• Sedentary: Exert up to 10 lb. of force occasionally and/or a minute amount frequently - 50-74%
• Light: Exert up to 20 lb. of force occasionally and/or up to 10 lb. of force frequently - 25-49%
• Medium: Exert 20 – 50 lb. of force occasionally and/or up to 15 lb. of force frequently - 1-24%
• Heavy: Exert 50 – 100 lb. of force occasionally and/or up to 30 lb. of force frequently - 1-24%
• Very Heavy: Exceed 100 lb. of force occasionally and/or 50 lb. frequently - 1-24%
H. Essential mental requirements
• Ability to read and comprehend simple instructions, short correspondence, and memos.Ability to write simple correspondence. Analytical and organizational skills must be above average.
I. Essential sensory requirements
• Ability to visually assess if a patient demonstrates symptoms that would require emergency treatment and care. Notify appropriate clinical staff to assess patient.
J. Other
• Hours- Must be flexible to work in different areas and locations as needed. This will include the ability to work all shifts including nights, weekends and holidays. Available to come in at short notice and maintain an on-call rotation. Expected to work 40 hours per week and overtime based on the demand and need of the department.
K. Equipment used
• HIS system, computer, fax, VOIP, phone system, headset system, speakers, billing and POS collections systems.
OTHER QUALIFICATIONS
A. Exposure to hazards (body fluid exposure level)
• Level III
B. Age of Patient Populations Served
• Neonates 1 - 30 days
• Infants 30 days - 1 year
• Children 1 - 12 years
• Adolescents 13 - 18 years
• Adults 19 - 70 years
• Geriatrics - 70+ years
JOB SPECIFIC DUTIES AND PERFORMANCE STANDARDS
• Below are those tasks, duties, and responsibilities that comprise the means of accomplishing the position’s purpose and objectives. These are critical or fundamental to the performance of the position. They are the major functions for which the person in the position is held accountable. Following are the essential functions of the position, along with the corresponding performance standards.
• Registration Duties
o Use scripting policies as an effective communication tool with customers. Greet patients in accordance with the department's script policy and procedure.
o Responsible and accountable for tasks necessary to properly identify and register into the patient processing system all patients presenting for admission.
o Ability to complete scheduling, registration, precertification, financial counseling, medical necessity checks effectively all patient types in the HIS system.
o Distribute necessary paperwork and forms to each patient registered including information on Advanced Directives, Patient Rights and Responsibilities, and Important Message from Medicare with complete and detailed explanation.
o Must keep abreast of current regulatory requirements, including all state, federal and JCAHO regulations. Keep up to date of requirements from each insurance payor (Medicare, Medicaid, Managed Care, Commercial or private payors, Tricare, etc.). Adhere to external agency regulations. Demonstrate the ability to complete meet the requirements of each payor according to their guidelines.
o Responsible for documenting all contact with patients, family, employers and third party payors.
o Insure patient flow through the registration process is professional, patient friendly and within department established time standards.
o Facilitate patient paper flow for accurate and complete medical records, financial forms and patient admission to nursing or ancillary units. Obtain authorized signatures on all required forms (Conditions of Admission, Important Message from Medicare, etc…).
o Ensure all physician orders meet current standards and policies. Obtain clarification on unclear or inappropriate orders. Determine proper patient processing according to physician orders. Appropriately enters the physician into the HIS system.
o Accurately transfer, and/or discharge, place orders, etc... for patients according to doctor's orders, and according to established policies and procedures.
o Demonstrates ability to complete status changes, upgrades, system change request according to policy and procedure.
• POS Collections
o Protect the financial standing of the hospital by appropriately determining financial responsibility. Contributes to department goals by making 100% of financial arrangements for each patient prior to services being performed.
o Review patient account history to establish acceptable payment arrangements, charity assistance or agency referral notifications. Refers accounts with bad debt history to the Patient Financial Services office or accounting representatives. Effectively calculate patient liability by reviewing patient insurance benefits. Effectively financial counsel patients for estimated patient liability.
o Collects account deposits on patient estimated balances, co-pays, co-insurance and unpaid deductibles. Meet collection goals as outlined by departmental policy and procedure.
o Initiates medically needy application for charity, catastrophic and indigent write-offs. Refers potential Medicaid patients to Medicaid Benefit Specialist for screening process.
o Review all responsible party demographics for useful collection purposes from all available sources (EX.-in-house computer systems, credit reports, outside sources).
o Completes all necessary forms (write off sheets, promissory notes, receipts, credit card reports, ABNs, etc…). Forwards to necessary departments. Initiates medical necessity check. Documents encounters in the HIS system.
o Makes deposits of money collected and receipts daily in department safe according to policy and procedure.
o Is able to explain all aspects of the billing account and procedure to a patient/guarantor.
• Accuracy , Insurance Billing and Precertification
o Maintains acceptable accuracy rate according to departmental guidelines.
o Meets with Education Coordinator weekly to discuss errors. Seeks ways to improve accuracy.
o Verify complete patient, guarantor and relative information. Makes every attempt to ensure proper patient identification using all possible means including, but not restricted to patient and guarantor social security number legal name, date of birth and address. Must adhere to Patient ID policy for identifying and updating patient information.
o Identify third party payor coverage, secures prior authorizations, referrals, notifications and precertification requirements prior to patient admission. Ensures fax notifications are complete.
o Maintains working knowledge of major third-party payer regulations and compliance issues.
o Distribute appropriate information to patients according to pay source, including to, but not restricted to Medicare, Medicaid, and Champus.
o Obtain incorrect or missing information in the insurance processor. Corrects accounts appropriately according to guidelines.
o Able to obtain and verify insurance benefits and eligibility. Methods available include patient/guarantor, insurance card or electronic means.
• Other Duties
o Follow proper chain of command for issues, complaints, etc.
o Demonstrates ability to respond appropriately to department and facility codes.
o Assist in orientation and training of new staff members. Able to help evaluate new staff member for readiness to fulfill job duties independently.
o Obtain room assignment from admissions nurse, patient care director or nursing unit according to doctor's orders.
o Escort patients to ancillary service department after the registration process is completed. Assure that each patient admitted to a bed is escorted to ancillary services and to the nursing unit in a wheelchair.
o Able to perform switchboard duties according to department policies and procedures.
o Complies with Time and Attendance according to policy and procedure. Attends to personal affairs to avoid conflicts with work. Schedules days off prior to posting of new schedule.
o Refill supplies in copier, printer, and fax machines at end of each shift.
o Perform any other task requested from Supervisor or Management in a willing and positive manner.
