Job Overview

Employment Type:

Part time

Shift:

Day Shift

Description:

This position is responsible for assisting the Director in managing daily operations within the assigned Ministry Organization’s (MO) Patient Access Department. Provides staff training, coaching and support; issue identification, assessment, and resolution; and technical support within the assigned work environment in order to achieve desired outcomes and compliance with Trinity Heath policies/procedures and standards. Provides input in hiring/firing decisions as well as performance appraisals. May perform quality reviews and analysis to support internal controls, monitor employee performance and assist in staff development, retention, and selection.

This position also provides a high level of technical competency and expertise analyzing and evaluating inpatient/ outpatient medical record information to identify and assign codes to diagnoses and procedures. Abstracts data from the medical record for the clinical database and prepares documents for the medical record and patient billing. Works collaboratively with the financial and clinical team members to ensure accurate billing. Serves as a subject matter expert regarding documentation, coding, billing, reimbursement, and compliance management. Serves as a key resource and assists in the denial management process. Responsible for facilitating education and providing informational material, work products and tools to staff in order to ensure documentation and coding accuracy, improve skills, and establish improved physician documentation opportunities.

SCOPE OF SERVICE:

Serve patients of all ages; physicians/providers; internal staff; and regulatory agencies.

ESSENTIAL FUNCTIONS:

Adheres to the principles of caring and expected behaviors outlined in MercyOne Medical Center's Model of Caring and Trinity Health's Code of Conduct, fostering a climate where all customers are treated in a manner consistent with MercyOne Medical Center's Mission and Values. Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health’s Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior. Assists the Director in the development of associate work schedules and assignments to ensure cost effective staffing providing optimal workflow needs that meets customer requirements In coordination with the Director may participate in the redesign of patient access processes and systems to improve service, data integrity, and staff productivity/quality to achieve departmental goals and process outcomes. Develops and communicates policies/procedures and other business documentation; conducts special studies and prepares key performance Indicators as they relate to the division (waiting/service times, accuracy, customer feedback, incident reporting, etc.). Collects and reports HIM, PAC, and other data requested for Quality Assurance Process. Assigns appropriate ICD-10-CM/PCS, and/or CPT codes, as well as appropriate modifiers and POA indicators, to all relevant diagnoses and procedures in accordance with accepted coding principals, standards, departmental guidelines, and in compliance with regulatory agencies. This includes, but is not limited to inpatient, emergency room visits, outpatient hospital visits, and recurring therapy visits. Utilizes a computerized encoding system and/or coding manuals. Provides technical coding knowledge and expertise to staff.

Services as a resource for coding staff to obtain information or clarification on accurate and ethical coding and documentation standards, guidelines, and regulatory requirements.

Continuously evaluates the quality of clinical documentation to identify incomplete or inconsistent documentation for all patient types that impact the code selection and resulting APC/DRG assignment.

Maintains up-to-date knowledge of changes in coding and reimbursement guidelines and regulations and eventually assisting staff to understand and implement these changes.

Acts as a team resource for questions, providing feedback and education to staff, clinical and non-clinical.

Assures timely coding of health information for statistical and reimbursement purposes.

Monitors unbilled account reports for outstanding services or un-coded accounts in an effort to reduce the Discharged-Not-Final-Coded (DNFC), Discharged-Not-Final-Billed (DNFB) and accounts receivable days for all patient types coded.

Maintains current knowledge of government-funded programs and other third-party payers in order to capture revenue effectively and accurately.

Reviews claim denials and rejections pertaining to coding and medical necessity issues and when necessary, implements a corrective action plan to prevent similar denials and rejections for recurring.

Communicates appropriately using interpersonal skills.

Positive, professional demeanor is projected through verbal and non-verbal communications.

Communicates effectively with clinical staff, physicians, office staff, CDI staff, Patient Financial Services and other staff within the hospital and Trinity Health.

Information is delivered in a manner that is supportive, timely and understandable.

Interpersonal conflicts are resolved using appropriate methods and organizational resources.

Positive working relationships with peers, management and customers are maintained at all times.

Acts as a resource person and assists with training of new colleagues as needed.

Assists in developing and implementing training and educational programs.

Facilitates and delivers effective educational tools and materials to assist the organization in integrating compliance in operations and improving processes and skills thereby reducing the possibility of futures audits and reviews.

Adheres to the organization's confidentiality requirements as they relate to the release of any individual or aggregate patient information. Keeps up to date on department policies and procedures. Participate as a leader in routine department meetings and training as required. Responsible for all aspects of Nursing Home Billing. Performs other duties as needed and assigned by the Director.

SKILLS AND ABILITIES REQUIRED

Maintains a professional, collaborative work environment so as to foster a positive public image for MercyOne Medical Center. Knows and adheres to all laws and regulations pertaining to patient health, safety, and medical information (i.e., HIPAA, Stark, etc.) Extensive comprehensive working knowledge of medical terminology, Anatomy and Physiology, disease processes, signs and symptoms, medications and laboratory values preferred. Ability to utilize both manual and automated versions of the ICD-10-CM and CPT4 coding classification systems. Must demonstrate the ability to meet and maintain accuracy/quality rating and minimum productivity standards as defined by department policies. Maintains current knowledge of patient accounting processes and systems, regulatory and 3rd party payer issues and requirements. Must be able to independently set and organize own work priorities for self and for the assigned team, and successfully adapt to new priorities as part of a changing environment. Must be able to work concurrently on a variety of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles. Must have excellent written and verbal communication skills with the ability to relate to people across all levels and diverse backgrounds. Uses interpersonal skills effectively to build and maintain cooperative working relationships with supervisory staff, medical staff, coworkers, and other healthcare personnel with providing information and services, seeking assistance and clarification, and resolving problems. Maintains an excellent working relationship within the department and with all of our internal and external customers. Ability to handle interactions with discretion, tact and courtesy when dealing with sensitive issues and confidential information. Ability to handle heavy workloads and short deadlines in a positive manner. Adapts quickly to changing conditions, assimilating new processes into job functions, and taking ownership. Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of MercyOne Medical Center. Demonstrates an understanding of organizational dynamics and administrative procedures and protocols. Ability to function in a dynamic, fast-paced team environment and to cope with ambiguity, time constraints, and other daily stressors in an effective and appropriate manner. Assigned hours within your shift, starting time, or days of work are subject to change based on the changing needs of the department and/or the organization. Must have ability to work flexible hours.

PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS:

Normal office environment where there are relatively few physical discomforts due to dust, dirt and noise. Works on-site 2-3 days per week in a 5-day work week. During an 8-hour day, must be able to stand/walk for 3 hours and sit 5 hours. Job requires occasional (<10% of work time) squatting, crawling, crouching, kneeling, and balancing; frequent (21-50% of work time) bending, stooping, reaching above shoulder level, pushing and pulling. Job requires the ability to frequently (21-50% of work time) lift and carry objects weighing approximately 11-24 pounds. Must have fine motor and manual dexterity skills to grip and manipulate items and perform repetitive action such as computer entry. Must be able to spend majority of work time utilizing a computer, monitor, and keyboard. Requires visual acuity, the ability to speak and the ability to hear speech. Job requires high level of mental concentration to attain established deadlines. Working environments includes frequent interruptions. Must be able to set and organize own work priorities and adapt to them as they change frequently. Must be able to work concurrently on a variety of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles. Must be able to travel on occasion to other worksites and training seminars. Must adhere to applicable organizational requirements on an annual basis for Employee Health Directives.

MINIMUM QUALIFICATIONS

(EDUCATION, LICENSURE, CERTIFICATION, AND EXPERIENCE REQUIRED):

Education, Licensure and Certification

Child and Dependent Adult Abuse Mandatory Reporter Training is required within 6 months of hire and every 5 years thereafter.

Completion of or currently enrolled in an accredited program by CAHIIM (Commission on Accreditation for Health Informatics and Health Information Management), or associate degree in Health Information Management or a related field or an equivalent combination of years of education and experience. Bachelor’s degree in HIM preferred.

Certification required in one of the following:

• RHIA (Registered Health Information Administrator),
• RHIT (Registered Health Information Technician)
• CCS (Certified Coding Specialist) or
• CCS-P (Certified Coding Specialist – Physician).

Experience

Prefer minimum 1-2 years' work experience as a Coder in an acute health care setting or strong training background in coding and reimbursement.

Prior managerial experience preferred.

Customer service background is required. Working knowledge of computer operations and electronic interfaces is required. Formal software course training is preferred.

Must be comfortable operating in a collaborative, shared leadership environment.

Experience with third party billing required.

Special Skills, Competencies, and Aptitudes Strong technical proficiency navigating the patient health record, with coding and encoder applications and hardware and other related applications or equipment. Comprehensive working knowledge of medical terminology, Anatomy and Physiology, disease processes, signs and symptoms, medications and laboratory values preferred. Computer Proficiency: Demonstrated experience and competency with Microsoft Office Suite, e-mail and a variety of web-based programs and browsers, with the willingness and ability to update and increase skills as needed to meet the goals of the departments. Ability to use other software as required to perform the essential functions of the job. Experience utilizing encoding/grouping software with emphasis on inpatient principles. Familiarity with distance learning or using web-based training tools desired. Proficient in the use of computer systems pertaining to coding, encoding, abstracting, Chart Deficiency, Chart Locator, and Master Patient Index.

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.