Documentation & Reimbursement Specialist Job at Nationwide Children's Hospital
Overview:
Here, Diversity, Equity and Inclusion are integrated into our core values and practices. We are passionate about building, sustaining and evolving an inclusive and equitable environment. We are seeking individuals who live these values and want to share their experiences and efforts in support of our collective mission.
Ask anyone with a Nationwide Children’s badge what they do for a living. They’ll tell you it’s More Than a Job. It’s a calling. It’s a chance to use and grow your talent to make an impact that truly matters. Because here, we exist simply to help children everywhere.
Nationwide Children’s Hospital. A Place to Be Proud.Responsibilities:
Researches and maintains knowledge of governmental regulations in coding and billing.
Certified Coding Specialist Physician Based (CCS-P) certification by the American Health Information Management Association (AHIMA)
Minimum Requirements:
Minimum Physical Requirements
The Documentation and Reimbursement Specialist is primarily responsible for actively investigating claim denials, performing root cause analysis, and responding to questions regarding documentation, coding, and billing of professional services. The Documentation and Reimbursement Specialist will perform claim reviews and conduct inpatient and outpatient chart reviews in order to determine billing appropriateness. He/she will work closely with the Director, Patient Accounts Professional Billing to resolve claim issues and provide feedback/education to providers, when appropriate.
[First 90 Days on-site, then hybrid in Ohio]
[Required: CCS-P or CPC and (5) years in related field]
Why Nationwide Children's Hospital?:
[Required: CCS-P or CPC and (5) years in related field]
The moment you walk through our doors, you feel it. When you meet our patient families, you believe it. And when you talk with anyone who works here, you want to be part of it. Welcome to Nationwide Children’s Hospital,
Where Passion Meets Purpose.
Here, Diversity, Equity and Inclusion are integrated into our core values and practices. We are passionate about building, sustaining and evolving an inclusive and equitable environment. We are seeking individuals who live these values and want to share their experiences and efforts in support of our collective mission.
We’re 14,000 strong. And it takes every one of us to improve the lives of the kids we care for, and the kids around the world we’ll never meet. Kids who live healthier, fuller lives because of the knowledge we share. We know it takes
a
Collaborative Culture to deliver on our promise to provide the very best, innovative care and to foster new discoveries, made possible by the most groundbreaking research. Anywhere.
Ask anyone with a Nationwide Children’s badge what they do for a living. They’ll tell you it’s More Than a Job. It’s a calling. It’s a chance to use and grow your talent to make an impact that truly matters. Because here, we exist simply to help children everywhere.
Nationwide Children’s Hospital. A Place to Be Proud.
Investigate, respond to and communicate information regarding coding, documentation, compliance and reimbursement questions.
- Compile and analyze data.
- Assist in identifying appropriate codes for specialized services.
- Support, provide analysis for and advise senior management regarding revenue and reimbursement issues.
- Work with Director to perform research and provide recommendations on appropriate use of billing codes in a timely manner.
- Analyze coding issues/questions from both a compliance and reimbursement perspective.
- Develop and implement a system for documenting and communicating responses to all coding, reimbursement, and compliance questions.
Provide compliance/documentation education sessions to physicians and other staff, as requested.
- Provide accurate and up-to-date information on regulatory and reimbursement requirements.
- Provide coding expertise for all compliance and reimbursement issues.
- Prepare reports and graphics for presentations.
- Maintain attendance lists for all presentations and logs of issues raised and identified for future research and response.
- Develop educational materials related to documentation, compliance and reimbursement, for physician and other staff.
Perform chart reviews for outpatient and inpatient physician services.
- In accordance with goals established by the Director, Patient Accounts Professional Billing, complete reviews within established timeframes, analyze results and prepare formal reports with findings and recommendations.
- Consult with physicians for clarification of clinical data when ambiguous information is encountered.
- Facilitate and improve physicians’ understanding of payer and regulatory requirements by providing feedback related to documentation information.
Oversee the design and updates of divisional billing forms and billing system dictionaries to ensure that all ICD-10 and CPT4 codes are up-to-date from both compliance and reimbursement perspectives.
- Design and implement a system for the annual revision of divisional billing slips, working with appropriate representatives from the coding, reimbursement, billing, and divisional areas.
- Develop and implement appropriate mechanisms for communicating all billing form and dictionary changes to the relevant staff. Access medical and billing documentation to evaluate coding and billing to ensure appropriate billing and coding practices are utilized.
Participate in the rejections and claims review process to ensure both compliance and the maximization of appropriate departmental reimbursement.
- Participate in regular meetings with billing and reimbursement staff to review claim rejections and develop appropriate strategies for addressing them.
- Review requests from insurers and patient families for copies of patient medical charts and/or changes in codes/fees.
- Participate in the development and implementation of systems/procedures related to rejection follow-up and strategies.
Work closely with Patient Accounts Supervisors and Director to ensure close collaboration and communication among billing teams to ensure close collaboration where hospital and physician coding are linked.
- Work with Patient Accounts Supervisors and Director on identifying and addressing general and service-specific questions.
- Ensure that issues identified are researched, addressed and communicated appropriately and in a timely fashion.
- Work with Patient Accounts Supervisors to provide training and educational materials for the billing teams, as needed.
- Coordinate review efforts with hospital staff where appropriate.
Researches and maintains knowledge of governmental regulations in coding and billing.
Participates in coding in-service programs and outside educational meetings.
Performs other duties as assigned.
Qualifications:
Required:
Certified Coding Specialist Physician Based (CCS-P) certification by the American Health Information Management Association (AHIMA)
or
Certified Professional Coder (CPC) certification by the American Academy of Professional Coders required.
Minimum of (5) years of experience in related field (physician billing experience preferred).
Minimum Requirements:
High school diploma or equivalent required.
Bachelor’s Degree preferred.
Minimum of one year of education/teaching related experience.
Proficiency with third party billing and documentation standards, particularly Evaluation and Management is essential.
Knowledge of medical terminology and proficiency with diagnosis and CPT4 coding required.
Excellent verbal and written communication skills.
Ability to maintain and establish strong working relationships with physicians, support staff, and external parties.
Able to work both as a team player and independently.
Strong analytical abilities.
Demonstrated aptitude for quantitative analysis and attention to detail.
Strong problem solving, collaboration, and interpersonal skills.
Able to balance multiple priorities and deadlines.
Proficiency with personal computers and related software.
Attention to patient confidentiality.
Minimum Physical Requirements
Must be able to see, hear, speak, read, and perform manual tasks with or without accommodation and care for oneself, with little or no difficulty. Performance of principal duties and responsibilities may require the ability to travel.
EOE M/F/Disability/Vet
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