When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.
Under direction from the Manger of HIM Audit and Research, is responsible for a variety of third party audits of medical record data for reimbursement, regulatory compliance, quality and appropriateness. Assists in the medical record documentation review for JCAHO compliance, editing of data required by the State Division of Health Care Financing and Policy and other projects/initiatives as necessary.
Job Description:
Essential Duties & Responsibilities including but are not limited to:
1. Audit Functions
Runs/creates reports from the 3M abstracting system for a variety of users, including the New England Organ Bank, and for verification of data for submission to the State Division of Health Care Finance and Policy.
Leads or assists in the performance of audits required by the Office of the Inspector General, Medicare, Federal Oversight Agencies and the Internal Audit department. Educates senior administrative and legal staff of documentation/Coding requirements and clinical issues as necessary.
Responds appropriately to miscellaneous requests from third party payors and the Patient Financial Services department, in order to achieve proper reimbursement, satisfy contractual obligations and assure compliance with regulations.
Interacts with H.I.M. managers, supervisors and section leaders to resolve record retrieval issues and other problems. Interacts with Physicians, Nurses, Administration, Patient Financial Services staff and third party payor personnel regarding reimbursement and documentation issues.
2. Judgment Initiatives
Minimum Qualifications:
Education: Clinical background (RN or LPN) and/or HIM degree/Coding certification strongly preferred, but equivalent working experience may be substituted.
Licensure, Certification, Registration: see above.
Skills, Knowledge & Abilities:
Knowledge of medical terminology, anatomy and physiology required.
Knowledge of ICD-9-CM Coding, CPT Coding and DRG payment methodologies helpful.
Knowledge of reimbursement policies and healthcare processes required.
Experience using Microsoft Word and Excel preferred.
Excellent oral and written communication skills required.
Demonstrated ability to handle multiple projects simultaneously and independently required.
Experience:
Pay Range:
$20.00 – $26.92
The pay range listed for this position is the base hourly wage range the organization reasonably and in good faith expects to pay for this position at this time. Actual compensation is determined based on several factors, that may include seniority, education, training, relevant experience, relevant certifications, geography of work location, job responsibilities, or other applicable factors permissible by law. Compensation may exceed the base hourly rate depending on shift differentials, call pay, premium pay, overtime pay, and other additional pay practices, as applicable to the position and in accordance with the law.
